Individual provider Active NPI

Mark Stephen Dolz, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Jacksonville, IL
National Provider Identifier
1104833631
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036094413 Issued in IL
Practice address
1600 W Walnut
Passavant Area Hospital - Laboratory
Jacksonville, IL 62650
Phone
(217) 245-9541
Fax
(217) 479-5648
NPI assigned
Aug 1, 2006
Last updated
Jun 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036094413 IL Primary

Addresses

Primary practice location

1600 W Walnut
Passavant Area Hospital - Laboratory
Jacksonville, IL 62650

Mailing address

7433 N 5TH St
McAllen, IL 68504
Phone (956) 410-9071

Other identifiers 1

IdentifierTypeStateIssuer
0360944131MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20171218002655 TX Practitioner - Pathology 4385606748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Pathology, P.a.Group PAC ID 2668516469, 5 clinicians

Practice addresses (Care Compare)

5501 S McColl Rd
Dr Hospital Renaissa
Edinburg, TX 78539-9152
Phone (956) 362-8677

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036094413ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Pathology PA Anatomic Pathology & Clinical Pathology CurrentSince Jun 17, 2019 Accepting new patients
Pathology Associates of Central Illinois LTD Anatomic Pathology & Clinical Pathology Past Accepting new patients

Locations

4750 N Expressway
#77
Brownsville, TX 78526
Phone (956) 362-1352

5501 S McColl Rd
Edinburg, TX 78539
Phone (956) 362-3300

5501 S Expressway 77
Harlingen, TX 78550
Phone (936) 569-9481

900 S Bryan Rd
Mission, TX 78572
Phone (956) 323-9000

1401 E 8th St
Weslaco, TX 78596
Phone (956) 581-0303

Organizations & group practices 2

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

Hospital & facility affiliations 6

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1104833631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7433 N 5TH ST",
            "city": "MCALLEN",
            "state": "IL",
            "postal_code": "68504",
            "telephone_number": "956-410-9071",
            "fax_number": "956-410-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT",
            "address_2": "PASSAVANT AREA HOSPITAL - LABORATORY",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "62650",
            "telephone_number": "217-245-9541",
            "fax_number": "217-479-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLZ",
        "first_name": "MARK",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2025-06-06",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036094413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360944131",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

Verify at the official NPI Registry.