Mark W Graves, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036-145917 Issued in IL

Practice address

751 N Rutledge St Ste 1100
Springfield, IL 62702-4968

Phone

(217) 545-8000

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

State licenses

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 and National Provider Directory roles.

• Board of Trustees of Southern Illinois University

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960
  Medicare reassignment NPD
• Siu Physicians & Surgeons, Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, IL
  • NPI 1558385989

  Internal Medicine

  Medicare reassignment NPD
• Board of Trustees of Southern Illinois University

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1568210425
  NPD
• Board of Trustees of Southern Illinois University

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1922350099
  NPD
• Siu Physicians & Surgeons, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1164055976
  NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1285702308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MADISON ST STE 328",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025131",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST STE 1100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477131227",
            "country_code": "US",
            "telephone_number": "812-426-9372",
            "fax_number": "812-858-4545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 E Clear Lake Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627031172",
            "country_code": "US",
            "telephone_number": "217-545-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01043637A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-145917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM IM IDENTIFICATION",
            "identifier": "000000109382",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200043550",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM NUC MED ID",
            "identifier": "000000277884",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY MEDICAID",
            "identifier": "64878861",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kwesi Grant-Acquah, MD
• Matthew Granzotto, MD
• Stacey Ann Graven, ACNP-BC
• Autumn Graves
• Christopher Mark Graves, MD
• Shannon Nicole Graves, APRN
• Gray Therapy Group, PLLC
• Blake Ashley Gray, MD
• Marissa Gray, LCSW
• Michael R Gray

• Internal Medicine Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; 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.