Individual provider Active NPI

Mary Jo Ironside, MD

  • Family Medicine Physician
  • Rockford, IL
National Provider Identifier
1275579658
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036069571 Issued in IL
Practice address
1221 E State St
Rockford, IL 61104-2231
Phone
(815) 972-1000
Fax
(815) 972-1086
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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 036069571 IL Primary

Addresses

Primary practice location

1221 E State St
Rockford, IL 61104-2231

Mailing address

1601 Parkview Ave
Credentialing S200C
Rockford, IL 61107-1822
Phone (815) 395-5861

Other identifiers 1

IdentifierTypeStateIssuer
036069571MedicaidIL

Other names 1

  • Mary Jo Ross Other name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100116000323 IL Practitioner - Family Practice 8325180151 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, 1,134 clinicians

Practice addresses (Care Compare)

1221 E State St
Rockford, IL 61104-2231
Phone (815) 972-1000

Hospital & facility affiliations

  • University of Illinois Hospital and Clinics Hospital, Chicago, IL, CCN 140150
  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital Family Medicine CurrentSince Apr 30, 2018 Accepting new patients
Swedishamerican Hospital CurrentSince Apr 30, 2018 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Apr 23, 2021 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois Family Medicine CurrentSince Nov 6, 2010 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Nov 6, 2010 Accepting new patients
Swedishamerican Hospital Family Medicine Current Accepting new patients

Locations

2170 Pearl St
Belvidere, IL 61008
Phone (815) 395-5886

7736 Solution Ctr
Chicago, IL 60677

1220 S Wood St
Chicago, IL 60608
Phone (312) 413-1261

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

1601 Parkview Ave
#S200C
Rockford, IL 61107

1221 E State St
Rockford, IL 61104
Phone (815) 972-1000

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

1601 Parkview Ave
Rockford, IL 61107
Phone (815) 395-0600

1511 N Blackhawk Blvd
Rockton, IL 61072
Phone (815) 395-5879

Interoperability endpoints

  • Direct secure messaging: dleinweber793884@direct.uwhealth.org
  • Direct secure messaging: mironside17620@uihealth.direct-ci.com

Organizations & group practices 29

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.

View all 29

Hospital & facility affiliations 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1275579658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PARKVIEW AVE",
            "address_2": "CREDENTIALING S200C",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071822",
            "telephone_number": "815-395-5861",
            "fax_number": "815-395-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042231",
            "telephone_number": "815-972-1000",
            "fax_number": "815-972-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRONSIDE",
        "first_name": "MARY JO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036069571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036069571",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY JO",
            "last_name": "ROSS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.