Individual provider Active NPI

Mary Elizabeth Gorman, M.D.

  • Otolaryngology Physician
  • Mattoon, IL
National Provider Identifier
1063636041
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036175158 Issued in IL
Practice address
1005 Health Center Dr Ste 201
Mattoon, IL 61938-4653
Phone
(217) 258-2409
Fax
(217) 258-2323
NPI assigned
Apr 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 036175158 IL Primary
Otolaryngology Physician 207Y00000X D69143 MD

Addresses

Primary practice location

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4653

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other names 1

  • Mary Elizabeth Pescitelli Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, MA, IL, FL4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20150423000492 MD Practitioner - Otolaryngology 6204974199 Reassigns benefits to 1 organization
I20240703002359 MA Practitioner - Otolaryngology 6204974199 Reassigns benefits to 1 organization
I20250617001631 IL Practitioner - Otolaryngology 6204974199 Reassigns benefits to 1 organization
I20251006002718 FL Practitioner - Otolaryngology 6204974199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1005 Health Ctr Dr
Suite 201
Mattoon, IL 61938-4653
Phone (217) 258-2409

Hospital & facility affiliations

  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036175158ILMDOtolaryngology Physician
D69143MDMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Jun 30, 2025 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 25, 2015 Accepting new patients
Lakeland Regional Health Systems, Inc. CurrentSince Oct 1, 2025 Accepting new patients
Ear, Nose & Throat Consultants, Inc Otolaryngology CurrentSince Jul 1, 2024 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Jun 30, 2025 Accepting new patients

Locations

3030 Harden Blvd
Lakeland, FL 33803
Phone (863) 687-1222

1324 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 687-1132

3525 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 603-6565

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1007 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-7400

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1021 Main St
Ste 105
Winchester, MA 01890
Phone (781) 729-8845

100 Sylvan Rd
Ste 750
Woburn, MA 01801
Phone (781) 731-3001

1701 Twin Springs Rd
Halethorpe, MD 21227
Phone (410) 737-5000

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 4EPEU
Rockville, MD 20852

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1063636041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384653",
            "telephone_number": "217-258-2409",
            "fax_number": "217-258-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036175158",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D69143",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1221 Mercantile Ln",
            "city": "Largo",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207745374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PESCITELLI",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.