Mario Gerard Massullo, D.O.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

036082059 Issued in IL

Practice address

1710 W. Court St.
Kankakee, IL 60901

Phone

(815) 936-3200

Fax

(815) 936-3203

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

Yes

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 IL

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

Specialty

Cardiac SurgeryAlso: Cardiovascular Disease (Cardiology), Internal Medicine, Osteopathic Manipulative Medicine, Peripheral Vascular Disease

Education

Ohio University, College of Osteopathic Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prime Healthcare Illinois Medical Group LLCGroup PAC ID 5597275685, 278 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155
• Iroquois Memorial Hospital Hospital, Watseka, IL, CCN 141353
• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186
• Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mario.massullo.1@15486.direct.athenahealth.com

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.

• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Specialty Physicians of Illinois, LLC

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1124075676

  IL

  Medicare reassignment NPD
• Specialty Physicians of Illinois, LLC

  • Urgent Care Clinic/Center
  • Frankfort, IL
  • NPI 1962024612
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Presence Central and Suburban Hospitals Network

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1770678260
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carle Surgicenter

  • Ambulatory Surgical Clinic/Center
  • Danville, IL
  • NPI 1225194533

  Hospital

  Care Compare affiliation
• Iroquois Memorial Hospital and Resident Home

  • Critical Access Hospital
  • Watseka, IL
  • NPI 1629003470
  Care Compare affiliation
• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation
• St Marys Hospital - Kankakee LLC

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1467290809
  Care Compare affiliation
• The Carle Foundation Hospital

  • General Acute Care Hospital
  • Urbana, IL
  • NPI 1013071653
  Care Compare affiliation

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1043228158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 W COURT ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013160",
            "telephone_number": "815-936-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 W. COURT ST.",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-936-3200",
            "fax_number": "815-936-3203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Provena Way Ste C",
            "address_purpose": "LOCATION",
            "city": "Bourbonnais",
            "state": "IL",
            "postal_code": "609144798",
            "country_code": "US",
            "telephone_number": "815-936-3200",
            "fax_number": "815-936-3203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASSULLO",
        "first_name": "MARIO",
        "middle_name": "GERARD",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036082059",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036082059",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036082059",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082059",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmassullo106367@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3800 W 203rd St Ste 202",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christine Marneris, M.A., CCC-A
• Andrea Marquez, BSN
• Deborah Mofoluwa Marshall
• Perry Marshall, D.O
• Abigail M Martinez, M.D.
• Elizabeth Maxwell
• Nancy Mayer
• Alexis G McConkey
• Stonewall McCuiston Jr., MD
• Anitra Ladawn Monique McCurry

• Cardiovascular Disease Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Cardiovascular Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.