Individual provider Active NPI

Peter Paul Mayock, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1285735142
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036084492 Issued in IL
Practice address
845 W Wilson Ave
Chicago, IL 60640-8090
Phone
(773) 506-4283
Fax
(773) 989-5986
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036084492 IL Primary

Addresses

Primary practice location

845 W Wilson Ave
Chicago, IL 60640-8090

Mailing address

845 W Wilson Ave
Chicago, IL 60640-8090
Phone (773) 506-4283

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
I20090914000122 IL Practitioner - Internal Medicine 1456407675 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036084492ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center Inc. CurrentSince Sep 22, 2015 Accepting new patients
Tapestry 360 Health Past Accepting new patients

Locations

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

251 E Huron St
Chicago, IL 60611

1504 S Albany Ave
Chicago, IL 60623

Interoperability endpoints

  • Direct secure messaging: peter.mayock.1@27315.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1285735142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 W WILSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606408090",
            "telephone_number": "773-506-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 W WILSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606408090",
            "telephone_number": "773-506-4283",
            "fax_number": "773-989-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYOCK",
        "first_name": "PETER",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036084492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.