MARK SEDERBERG (D.O.) – Sports Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1255793576

MARK SEDERBERG (D.O.) is a healthcare provider. based in Fort worth, Texas. specializing in PHYSICAL MEDICINE AND REHABILITATION. They hold the professional credentials D.O.. They hold a License No. 11741897-1204 (UT). The NPI Number for MARK SEDERBERG (D.O.) is 1255793576

Main info

Male
10 Years Of Experience
Accepts Medicare Assignment
Name
MARK SEDERBERG (D.O.)
NPI
1255793576
Phone
(817) 702-3431
Address
1500 S Main St
Enumeration Date
25 March 2016
Last Update Date
11 June 2020

Doctor Profile

Medical School Name
UNIVERSITY OF NORTH TEXAS HSC, COLLEGE OF OSTEOPATHIC MED
Secondary Phone
8017537770
Graduation Year
2016 (10 years ago)
PAC ID
2769778737
Group Practice PAC ID
6204140122
Professional Enrollment ID
I20200612000595
Address ID
UT840437497LE3401XSTXX401
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience49
Completeness75
Years active:10State licenses:1Digital endpointsOther names

863 PHYSICAL MEDICINE AND REHABILITATION in TX

Provider Addresses for MARK SEDERBERG (D.O.)

  • 1500 S Main St

    Fort Worth, TX 761044917

    Phone: (817) 702-3431

    Type: Location

  • 590, Wakara Way, Research Park, Salt Lake City, Salt Lake County, Utah, 84108, United States

    SALT LAKE CITY, UT 841081200

    Phone: (801) 587-5400

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $79.

Total Amount is formed as General ($79) + Research ($0) + Ownership ($0) = $79.

Last reported payment date: 2024-11-18 • Largest payer in this snapshot: Orthofix Medical, Inc. ($25).

Total Amount

$79

General + Research + Ownership

Payments

4

Total payment records

General Amount

$79

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2020-06-12

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
I20200612000595IPhysical Medicine And RehabilitationUTTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg16028$0
99214Established patient office or other outpatient visit, 30-39 minutes8946$0
20611Aspiration and/or injection of fluid large joint using ultrasound guidance2115$0
99204New patient office or other outpatient visit, 45-59 minutes2020$0
View full utilization report →

Insurance plans in this area (ZIP 76104)

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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: 6204140122View full group profile
NameSpecialtyState
Sports MedicineUT
Sports MedicineUT
Orthopedic Surgery, Sports MedicineMS
Family PracticeIN
Sports Medicine, Family PracticeUT
Family Practice, Sports MedicineWY

Reviews

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Frequently asked questions

What is the standard ID for MARK SEDERBERG (D.O.) in the U.S.?
In the U.S., MARK SEDERBERG (D.O.) is identified by NPI 1255793576.
Does the public listing show MARK SEDERBERG (D.O.) as active?
MARK SEDERBERG (D.O.)'s NPI record reflects an active status in NPPES.
What type of care does MARK SEDERBERG (D.O.) provide?
MARK SEDERBERG (D.O.)'s profile centers on Sports Medicine (Physical Medicine & Rehabilitation) Physician. Clinical services aligned with this taxonomy classification.
What city is tied to MARK SEDERBERG (D.O.)?
The directory associates MARK SEDERBERG (D.O.) with Fort Worth, Texas. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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