NPIMap

Individual provider Active NPI

Mark E Peterson, MD

  • Internal Medicine Physician
  • Oswego, IL
National Provider Identifier
1114030384
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-111051 Issued in IL
Practice address
80 Templeton Dr
Oswego, IL 60543-7000
Phone
(630) 554-3456
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-111051 IL Primary

Addresses

Primary practice location

80 Templeton Dr
Oswego, IL 60543-7000

Mailing address

2357 Sequoia Dr
Aurora, IL 60506-6222
Phone (630) 859-6800

Other identifiers 1

IdentifierTypeStateIssuer
036111051MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mpeterson206493@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040807000102 IL Practitioner - Internal Medicine 4981676251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

80 Templeton Dr
Oswego, IL 60543-7000
Phone (630) 554-3456

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-111051ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients

Locations

2357 Sequoia Dr
Aurora, IL 60506
Phone (630) 859-6700

1221 N Highland Ave
Aurora, IL 60506
Phone (630) 859-6700

28594 Network Pl
Chicago, IL 60673

80 Templeton Dr
Oswego, IL 60543
Phone (630) 551-2760

Interoperability endpoints

  • Direct secure messaging: mpeterson206493@direct.myadvocateaurora.org

Organizations & group practices 3

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 8

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1114030384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 SEQUOIA DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605066222",
            "telephone_number": "630-859-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 TEMPLETON DR",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605437000",
            "telephone_number": "630-554-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-111051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111051",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson206493@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "80 Templeton Dr",
            "city": "Oswego",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605437000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "80 Templeton Dr",
            "city": "Oswego",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605437000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oswego, IL

Sources for this page

Verify at the official NPI Registry.