Individual provider Active NPI

Mark D Lauffer, PA

  • Surgical Physician Assistant
  • Peoria, IL
National Provider Identifier
1184927709
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
385-002737 Issued in IL
Practice address
6000 N Allen Rd
Peoria, IL 61614-3294
Phone
(309) 691-1400
Fax
(309) 693-3175
NPI assigned
Dec 21, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 385-002737 IL Primary

Addresses

Primary practice location

6000 N Allen Rd
Peoria, IL 61614-3294

Mailing address

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

Other identifiers 1

IdentifierTypeStateIssuer
0850003967MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110216000659 IL Practitioner - Physician Assistant 2466633961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians
Midwest Orthopaedic Center S CGroup PAC ID 8022917715, 45 clinicians

Practice addresses (Care Compare)

300 Tenney St
Kewanee, IL 61443-3452
Phone (309) 853-5500

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
385-002737ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Feb 6, 2013 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Feb 6, 2013 Accepting new patients

Locations

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

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 4

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": "1292889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1184927709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400",
            "fax_number": "309-693-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400",
            "fax_number": "309-693-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUFFER",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-21",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "385-002737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0850003967",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.