NPIMap

Individual provider Active NPI

Mary Connolly, M.D.

  • Family Medicine Physician
  • Naperville, IL
National Provider Identifier
1174790141
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036121843 Issued in IL
Practice address
1220 Hobson Rd
204
Naperville, IL 60540-8139
Phone
(630) 416-7766
NPI assigned
May 9, 2008
Last updated
Jan 20, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036121843 IL Primary

Addresses

Primary practice location

1220 Hobson Rd
204
Naperville, IL 60540-8139

Mailing address

1860 Paysphere Cir
Chicago, IL 60674-0018
Phone (630) 416-7766

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
I20090909000356 IL Practitioner - Family Practice 1254486665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Morris HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

25259 S Reed St
Channahon, IL 60410-6003
Phone (815) 467-0555

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital Family Medicine CurrentSince Mar 1, 2012 Accepting new patients
Morris Hospital Current Accepting new patients
Morris Hospital CurrentSince Mar 1, 2012 Accepting new patients
Morris Hospital Current Accepting new patients
Dupage Medical Group LTD Past Accepting new patients

Locations

389 E Main St
Braidwood, IL 60408
Phone (815) 458-2532

25259 S Reed St
Channahon, IL 60410
Phone (815) 467-0555

580 Sycamore St
Marseilles, IL 61341
Phone (815) 795-2122

150 W High St
Morris, IL 60450
Phone (815) 942-2129

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: mary.connolly.1@14307.direct.athenahealth.com
  • Direct secure messaging: mary.connolly@direct-address.org

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, 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": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1174790141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740018",
            "telephone_number": "630-416-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 HOBSON RD",
            "address_2": "204",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605408139",
            "telephone_number": "630-416-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036121843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.