MARK J SWOFFORD DO
NPI 1245238484
Urology in Pikeville, KY

Q: What is Mark Swofford's NPI number?

The NPI number for Mark Swofford is 1245238484. It was assigned to this individual provider in the NPPES registry on July 12, 2005.

Q: What is Mark Swofford's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Q: When was this NPI record last updated?

The NPPES record for Mark Swofford was last updated on June 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 12, 2005PECOS EnrolledAccepts Medicare Assignment

86.86/100

CMS Quality Rating

911 BYPASS RD BLDG A, PIKEVILLE, KY 41501(606) 430-2202(606) 218-7502 Get Directions Write a Review

NPPES record last updated: June 7, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 7, 2022, Apr 28, 2021 (2 updates tracked since 2021).

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About Mark J Swofford Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK J SWOFFORD DO (NPI 1245238484) is an individual urology provider in Pikeville, Kentucky, licensed in Kentucky (02625) and active in the NPI registry since July 2005. He is enrolled in Medicare PECOS, is affiliated with Pikeville Medical Center, and is a graduate of At Still University Of Health Sciences, College Of Osteo Med, Kirksville (1990).

NPPES Registry Identity

NPI1245238484

Entity TypeIndividualMale

Primary Taxonomy208800000X

Provider Legal NameMARK J SWOFFORDCredential: DO

Location Address911 BYPASS RD BLDG APikeville, KY 41501-1689

Mailing AddressPo Box 432Pikeville, KY 41502-0432 · (606) 430-2202 · Fax (606) 218-7502

Phone(606) 430-2202

Fax(606) 218-7502

Sole ProprietorNo

Medical School CMSAt Still University Of Health Sciences, College Of Osteo Med, KirksvilleGraduated 1990

Enumeration DateJuly 12, 2005

Last NPPES UpdateJune 7, 20222 updates tracked since enumeration

NPPES CertifiedJune 7, 2022

✔ NPI 1245238484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians

Taxonomy Code208800000X

License✔ Licensed in KY · 02625

Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

911 BYPASS RD BLDG A, Pikeville, KY 41501

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Other Identifiers 1

Medicaid65935009KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mark J Swofford Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3779578786

PECOS Enrollment IDI20110212000083

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

405 services293 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

48 services48 patients

Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

42 services40 patients

Diagnostic exam of bladder and urethra using an endoscope 52000

This procedure involves using a thin, flexible tube with a light, called an endoscope, to examine the bladder and urethra. It helps in identifying any abnormalities or issues that may be causing discomfort or other symptoms.

30 services24 patients

Crushing of stone of ureter using an endoscope 52353

This procedure involves using a thin, flexible instrument called an endoscope to reach a stone in your ureter. The stone is then broken into small pieces using a special tool. These pieces can then pass out of the body naturally.

13 services13 patients

Exam of bladder and urethra for treatment of female urethral syndrome using an endoscope 52285

This procedure involves a special tool called an endoscope to visually inspect your bladder and the tube that carries urine out of your body. It's performed to help diagnose and treat discomfort related to urinary issues.

12 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Pikeville Medical Center

Acute Care Hospitals · Pikeville, KY

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number180044

Location911 Bypass RoadPikeville, KY 41501 · Pike County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$122.77 typical visit price

range $52.76 – $162.27

Typical copayment $30.69 (range $13.19 – $40.56)

Most-billed visit code 99204

Established Patient

$66.24 typical visit price

range $16.53 – $131.99

Typical copayment $16.56 (range $4.13 – $32.99)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

86.86/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

72.39

Promoting Interoperability

100

Improvement Activities

Cost

70.65

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Lubricant, individual sterile packet, each A4332

DME-Medical/Surgical Supplies · category DA000N

2 suppliers14 claims1,860 services$0.10 avg. paid by Medicare

Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351

DME-Orthotic Devices · category DF008N

3 suppliers36 claims5,496 services$1.42 avg. paid by Medicare

Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each A4352

DME-Orthotic Devices · category DF008N

3 suppliers15 claims3,150 services$5.27 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. WHITNEY P. BURTON PA-C

Physician Assistant