NPIMap

Individual provider Active NPI

Mark Allen Grevious, M.D.

  • Plastic Surgery Physician
  • Munster, IN
National Provider Identifier
1194727909
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
72578 Issued in MN
Practice address
7905 Calumet Ave
Munster, IN 46321-2549
Phone
(219) 836-7506
Fax
(219) 836-7515
NPI assigned
Aug 11, 2005
Last updated
Apr 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 036100551 IL
Plastic Surgery Physician 208200000X 01060561A IN
Plastic Surgery Physician 208200000X 72578 MN Primary
Surgery Physician 208600000X 036100551 IL
Surgery Physician 208600000X 01060561A IN
Plastic and Reconstructive Surgery Physician 2086S0122X 036100551 IL

Addresses

Primary practice location

7905 Calumet Ave
Munster, IN 46321-2549

Mailing address

849 W Ohio St
Chicago, IL 60642-6982

Other practice location 1

3900 W 203rd St
Olympia Fields, IL 60461-1183
Phone (708) 855-7071

Other practice location 2

1740 W Taylor St
Chicago, IL 60612-7232
Phone (312) 996-7000

Other identifiers 1

IdentifierTypeStateIssuer
036-100551-1MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mgrevious68096@Direct.FranciscanAlliance.org Direct
Direct Messaging Address mgrevious@direct.ccprovider.org Direct Cook County

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
I20060505000390 IL Practitioner - Plastic and Reconstructive SurgeryPractitioner - Hand Surgery 0840201885 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Hand Surgery
Education
Rutgers New Jersey Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians
Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Practice addresses (Care Compare)

1009 S Wood St
Chicago, IL 60612-3747
Phone (312) 355-4300

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

3900 W 203Rd St
Olympia Fields, IL 60461-1183
Phone (708) 679-2380

500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72578MNMDPlastic Surgery Physician
01060561AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Illinois Medical Group LLC CurrentSince Jun 28, 2025 Accepting new patients
Rockford Health Physicians CurrentSince Aug 28, 2019 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jun 15, 2024 Accepting new patients
Specialty Physicians of Illinois, LLC Surgery CurrentSince Apr 13, 2024 Accepting new patients
The Board of Trustees of the University of Illinois Plastic Surgery CurrentSince Jun 15, 2024 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Cook County Current Accepting new patients
Cook County Surgery CurrentSince Apr 18, 2018 Accepting new patients
Cook County CurrentSince Apr 18, 2018 Accepting new patients
Specialty Physicians of Illinois, LLC CurrentSince Apr 13, 2024 Accepting new patients
Orthopedic Specialists of Northwest Indiana LLC Past Accepting new patients
John H Stroger Jr Hospital Cook County Past Accepting new patients

Locations

1801 W Olympic Blvd
#2636
Pasadena, CA 91199

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

100 Provena Way
Ste 103
Bourbonnais, IL 60914
Phone (815) 937-8780

Carol Stream, IL 60122

1740 W Taylor St
Chicago, IL 60612
Phone (312) 355-4000

1801 W Taylor St
#3F
Chicago, IL 60612
Phone (312) 355-4300

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

35318 Eagle Way
Chicago, IL 60678

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

820 S Wood St
Ste 515
Chicago, IL 60612
Phone (312) 996-9313

100 N River Rd
Des Plaines, IL 60016
Phone (847) 297-1800

201 N Hammes Ave
Joliet, IL 60435
Phone (224) 273-6350

3700 W 203rd St
Ste 301
Olympia Flds, IL 60461
Phone (708) 679-2850

3900 W 203rd St
Olympia Flds, IL 60461
Phone (708) 478-7437

2300 N Rockton Ave
Rockford, IL 61103

2780 McFarland Rd
Rockford, IL 61107
Phone (815) 637-0000

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

5454 Hohman Ave
Hammond, IN 46320
Phone (219) 933-2077

Interoperability endpoints

  • Direct secure messaging: mgrevious@direct.ccprovider.org
  • Direct secure messaging: mgrevious@osnwi1911.srs-direct.com
  • Direct secure messaging: mgrevious167716@uihealth.direct-ci.com
  • Direct secure messaging: mgrevious68096@direct.franciscanalliance.org

Organizations & group practices 12

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 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1194727909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 W OHIO ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606426982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7905 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212549",
            "telephone_number": "219-836-7506",
            "fax_number": "219-836-7515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 W 203rd St",
            "address_purpose": "LOCATION",
            "city": "Olympia Fields",
            "state": "IL",
            "postal_code": "604611183",
            "country_code": "US",
            "telephone_number": "708-855-7071",
            "fax_number": "708-503-3224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1740 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127232",
            "country_code": "US",
            "telephone_number": "312-996-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREVIOUS",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036100551",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01060561A",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MN",
            "license": "72578",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036100551",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01060561A",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036100551",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-100551-1",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgrevious68096@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7905 Calumet Ave",
            "city": "Munster",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463212549",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgrevious@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.