NPIMap

Organization Active NPI

Mark K Chang MD

Doing business as Midwest Spinecare

  • Orthopaedic Surgery of the Spine Physician
  • Dyer, IN
National Provider Identifier
1053579912
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
036095817 Issued in IL
Legal business name
MARK K CHANG MD
Doing business as
Midwest Spinecare
Practice address
1100 Joliet St
Suite 104
Dyer, IN 46311-1996
Phone
(219) 836-4955
NPI assigned
May 28, 2008
Last updated
Jan 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

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

Authorized official

Name
Mark K Chang, MDNPI 1871607507
Title
Medical Director
Phone
(219) 836-4955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X 036095817 IL Primary

Addresses

Primary practice location

1100 Joliet St
Suite 104
Dyer, IN 46311-1996

Mailing address

1100 Joliet St
Suite 104
Dyer, IN 46311-1996
Phone (219) 836-4955

Other identifiers 2

IdentifierTypeStateIssuer
03609507MedicaidIL
5930340001OtherILRR MEDICARE

Other names 1

  • MIDWEST SPINECARE Doing business as

National Provider Directory

National Provider Directory

Locations

1100 Joliet St
Ste 104
Dyer, IN 46311
Phone (219) 836-4955

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1053579912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 JOLIET ST",
            "address_2": "SUITE 104",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111996",
            "telephone_number": "219-836-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 JOLIET ST",
            "address_2": "SUITE 104",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111996",
            "telephone_number": "219-836-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK K CHANG MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-28",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "219-836-4955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IL",
            "license": "036095817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03609507",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "5930340001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDWEST SPINECARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyer, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; 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.