Mark Gibson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036093663 Issued in IL

Practice address

150 W High St
Morris, IL 60450-1463

Phone

(815) 942-2932

NPI assigned

Jun 28, 2006

Last updated

Jun 1, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Epic Group-Emergency Physicians an Illinois Concern S.C.

  • Emergency Medicine Physician
  • Morris, IL
  • NPI 1447283569
  Medicare reassignment NPD
• Morris Hospital

  • General Practice Physician
  • Morris, IL
  • NPI 1558466268

  Emergency Medicine

  Medicare reassignment NPD
• Morris Hospital

  • Clinical Medical Laboratory
  • Morris, IL
  • NPI 1003916412
  NPD
• Morris Hospital

  dba Morris Hospital & Healthcare Centers

  • General Acute Care Hospital
  • Morris, IL
  • NPI 1649370057
  NPD

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306886400000",
    "number": "1275561524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66973",
            "address_2": "SLOT 303125",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606660973",
            "telephone_number": "877-852-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W HIGH ST",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501463",
            "telephone_number": "815-942-2932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2011-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036093663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930081199",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360936631",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Melvin Arquiza Galon, PT
• George a Roebuck
• Germane Nephrology Associates (Morris Nephrology Associates)
• Jonathon A Gholson
• John Thomas Giannone, O.D.
• Courtney L Gigler
• Terri Jo Gillette, D.C.
• Reilly Glefke
• Rifki J. Goldin Mertdogan, M.D.
• Kimberly Gomez

• Emergency Medicine Physician in Morris, IL
• Providers in Morris, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.