MARK PEMBERTON – Mental Health Counselor, NPI 1396103057

MARK PEMBERTON is a healthcare provider. based in Amherst, Ohio. specializing in MENTAL HEALTH COUNSELOR. They hold a License No. 131151 (OH). The NPI Number for MARK PEMBERTON is 1396103057

Main info

Female
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
MARK PEMBERTON
NPI
1396103057
Phone
Not provided
Address
500 STONE VALLEY DR
Enumeration Date
9 February 2016
Last Update Date
9 February 2016

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4407344037
Graduation Year
2015 (11 years ago)
PAC ID
8123467552
Group Practice PAC ID
5092713529
Professional Enrollment ID
I20240418002294
Address ID
OH441262212FA22540RDXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience43
Completeness75
Years active:10State licenses:2Digital endpointsOther names

2,538 MENTAL HEALTH COUNSELOR in OH

Provider Addresses for MARK PEMBERTON

  • 500 STONE VALLEY DR

    AMHERST, OH 440012590

    Phone:

    Type: Mailing

  • 1925 HAYES AVE

    SANDUSKY, OH 448704737

    Phone: (419) 557-5177

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-04-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240418002294IMental Health CounselorOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44001)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5092713529View full group profile
NameSpecialtyState
Mental Health CounselorOH
-OH
Mental Health CounselorOH
Clinical PsychologistOH
Clinical Social WorkerOH
Clinical Social WorkerOH
-OH
Mental Health CounselorOH
Clinical Social WorkerOH

Reviews

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Frequently asked questions

Can I cross-check MARK PEMBERTON using NPI 1396103057?
NPI 1396103057 belongs to MARK PEMBERTON; compare other details if you need extra assurance.
Active or inactive — what applies to MARK PEMBERTON?
You should see MARK PEMBERTON as active in CMS-hosted NPPES data.
What clinical focus is listed for MARK PEMBERTON?
At a glance, MARK PEMBERTON is tied to Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Is MARK PEMBERTON located near Amherst?
MARK PEMBERTON currently maps to Amherst, Ohio in this extract.
Can I trust this NPI listing for MARK PEMBERTON?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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