{
"Npi": {
"NPI": "1336128222",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOVACH",
"FirstName": "MARK",
"MiddleName": "W",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 959354",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT LOUIS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63195-9354",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-916-9615",
"MailingAddressFaxNumber": "636-916-9850",
"FirstLinePracticeLocationAddress": "201 BJC SAINT PETERS DR STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PETERS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63376-3386",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-916-9615",
"PracticeLocationAddressFaxNumber": "636-916-9850",
"EnumerationDate": "01/10/2006",
"LastUpdateDate": "12/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207RC0001X",
"TaxonomyName": "Clinical Cardiac Electrophysiology Physician",
"LicenseNumber": "036098054",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207RC0001X",
"TaxonomyName": "Clinical Cardiac Electrophysiology Physician",
"LicenseNumber": "V4257",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RC0001X",
"TaxonomyName": "Clinical Cardiac Electrophysiology Physician",
"LicenseNumber": "159182",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RC0001X",
"TaxonomyName": "Clinical Cardiac Electrophysiology Physician",
"LicenseNumber": "2025044853",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}