Douglas Adolph Mazurek, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

01038566A Issued in IN

Practice address

1101 Glendale Blvd
Suite 103
Valparaiso, IN 46383-3767

Phone

(219) 464-9054

Fax

(219) 465-1749

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

90.68 of 100Reported as apm

Quality

76.2

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680
  Medicare reassignment NPD
• Porter Physician Services LLC

  • Internal Medicine Physician
  • Portage, IN
  • NPI 1457566309
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1033223235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 KELLE DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463048708",
            "telephone_number": "219-364-3616",
            "fax_number": "219-364-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 GLENDALE BLVD",
            "address_2": "SUITE 103",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463833767",
            "telephone_number": "219-464-9054",
            "fax_number": "219-465-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUREK",
        "first_name": "DOUGLAS",
        "middle_name": "ADOLPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "01038566",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "01038566",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "01038566A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200016720",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "douglas.mazurek.1@direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "1101 Glendale Blvd",
            "address_2": "Suite 103",
            "city": "Valparaiso",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463833767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maureen Quinn Counseling
• Branda-Lee Maurushes, LCSW
• Maw Medicine PC
• Jennifer M Maya, MD
• Aymn Mazhar, MBBS
• Mitchell J Mazurek, MD
• Patricia H. McAfee, CCC-SLP
• Richard Scott McAfee Jr., OD
• Chloe Katherine McBride, DDS
• Robert Brian McBride, MD

• Specialist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.