Individual provider Active NPI

Mary R Hoffman, MD

  • Family Medicine Physician
  • Springfield, IL
National Provider Identifier
1316984057
Registry record updated Jan 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-110636 Issued in IL
Practice address
520 N 4TH St
Springfield, IL 62702-5238
Phone
(217) 545-8000
Fax
(217) 747-1351
NPI assigned
Jun 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 036110636 IL
Family Medicine Physician 207Q00000X 036-110636 IL Primary

Addresses

Primary practice location

520 N 4TH St
Springfield, IL 62702-5238

Mailing address

520 N 4TH St
PO Box 19670
Springfield, IL 62702-5238
Phone (217) 545-8000

Other practice location 1

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

Other practice location 2

2 Memorial Dr Ste 220
Alton, IL 62002-6723
Phone (618) 433-7901

Other identifiers 2

IdentifierTypeStateIssuer
1316984057MedicaidMO
036110636MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address maryhoffman@siusm.allscriptsdirect.net
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20061116000374 IL Practitioner - Family PracticePractitioner - Hospitalist 1850357526 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

2615 Edwards St
Alton, IL 62002-3915
Phone (618) 462-4342

4 Memorial Dr
Suite 210
Alton, IL 62002-6704
Phone (618) 463-5905

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-110636ILMDFamily Medicine Physician
036110636ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University CurrentSince Jun 1, 2017 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Jun 1, 2017 Accepting new patients
Southern Illinois Healthcare Foundation, Inc Family Medicine CurrentSince Mar 3, 2021 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Jan 1, 2022 Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine Current Accepting new patients
Fairview Heights Medical Group SC CurrentSince Jan 1, 2022 Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Mar 3, 2021 Accepting new patients
Southern Illinois Healthcare Foundation Inc Family Medicine Current Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

2 Memorial Dr
Ste 220
Alton, IL 62002
Phone (618) 462-6200

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

Interoperability endpoints

  • Direct secure messaging: mary.hoffman.1@9559.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735948800000",
    "number": "1316984057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 4TH ST",
            "address_2": "PO BOX 19670",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025238",
            "telephone_number": "217-545-8000",
            "fax_number": "217-747-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 4TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025238",
            "telephone_number": "217-545-8000",
            "fax_number": "217-747-1351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Alton",
            "state": "IL",
            "postal_code": "620026722",
            "country_code": "US",
            "telephone_number": "618-463-7240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Memorial Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Alton",
            "state": "IL",
            "postal_code": "620026723",
            "country_code": "US",
            "telephone_number": "618-433-7901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOFFMAN",
        "first_name": "MARY",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2025-01-04",
        "certification_date": "2025-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036110636",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-110636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316984057",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110636",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maryhoffman@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "520 N 4th St",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627025238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Memorial Dr",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.