Mario Donald Hodge, C.PED

Primary specialty

PedorthistTaxonomy code 224L00000X

License

212.000161 Issued in IL

Practice address

1024 Jordan St
Mount Vernon, IL 62864-4231

Phone

(618) 242-4442

Fax

(618) 242-3942

NPI assigned

Sep 25, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vivian L Martin

  • Prosthetic/Orthotic Supplier
  • Mount Vernon, IL
  • NPI 1194078816
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1023369501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 JORDAN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644231",
            "telephone_number": "618-242-4442",
            "fax_number": "618-242-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 JORDAN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644231",
            "telephone_number": "618-242-4442",
            "fax_number": "618-242-3942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGE",
        "first_name": "MARIO",
        "middle_name": "DONALD",
        "name_prefix": "Mr.",
        "credential": "C.PED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-25",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "IL",
            "license": "212.000161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea M. Hills, MS CCC/SLP
• Andrew David Hinds, ATC
• Michael R Hiner, D.D.S.
• Erin Hocking Ayers, O.D.
• Holli Danel Hodge
• Ashley C Hofer, NP
• Daniel Hoffman, MD
• Lucinda M. Holdren, CADC
• Lawrence Hollander, MD, FACS
• Nikia Hollenkamp-Rudd

• Pedorthist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Pedorthist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.