NPIMap

Individual provider Active NPI

Mark D Taber, M.D.

  • Cardiovascular Disease Physician
  • Wentzville, MO
National Provider Identifier
1336100650
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036062673 Issued in IL
Practice address
1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone
(636) 497-4055
NPI assigned
Mar 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X R9F84 MO
Interventional Cardiology Physician 207RI0011X R9F84 MO
Cardiovascular Disease Physician 207RC0000X 036062673 IL Primary

Addresses

Primary practice location

1520 Wentzville Pkwy
Wentzville, MO 63385-3408

Mailing address

1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone (636) 497-4055

Other practice location 1

5401 Veterans Memorial Pkwy Ste 101
Saint Peters, MO 63376-1681
Phone (636) 939-4820

Other practice location 2

12855 N Forty Dr
Suite 300
Saint Louis, MO 63141
Phone (314) 880-6100

Other practice location 3

4445 W Irving Park Rd Ste 200
Chicago, IL 60641-2808
Phone (312) 664-3278

Other identifiers 1

IdentifierTypeStateIssuer
202265807MedicaidMO

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address mtaber19907@direct-ehr-ssmhc.com Direct
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address mtaber19907@direct-ehr-ssmhc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240528003264 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9436102241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Northwestern University Feinberg Medical School, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1135 S Delano CT E
Chicago, IL 60605-3457
Phone (630) 933-1500

1135 W Delano CT
A201
Chicago, IL 60605-3457
Phone (312) 695-0665

1630 Sherman Ave
Evanston, IL 60201-3711

350 S Waukegan
Suite 150
Deerfield, IL 60015-5239
Phone (312) 926-3107

350 S Waukegan Rd
Deerfield, IL 60015-5239
Phone (312) 926-6146

4445 W Irving Park Rd
Chicago, IL 60641-2808

4732 N Lincoln Ave
Chicago, IL 60625-8561
Phone (847) 475-2273

636 Raymond Dr
Suite 107
Naperville, IL 60563-9789
Phone (630) 416-2300

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

870 N Milwaukee Ave
Vernon Hills, IL 60061-1521

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2024 Accepting new patients
SSM Cardiovascular and Thoracic Services, Inc. Cardiovascular Disease Past Accepting new patients
SSM Health Care St. Louis Cardiovascular Disease Past Accepting new patients
Metro Heart Group of St. Louis, Inc. Past Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

4445 W Irving Park Rd
Ste 200
Chicago, IL 60641
Phone (312) 664-3278

1630 Sherman Ave
Ste 200
Evanston, IL 60201
Phone (847) 534-3278

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Interoperability endpoints

  • Direct secure messaging: mtaber19907@direct-ehr-ssmhc.com

Organizations & group practices 19

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 19

Hospital & facility affiliations 3

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.

{
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    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1336100650",
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            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853408",
            "telephone_number": "636-497-4055"
        },
        {
            "country_code": "US",
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        }
    ],
    "practiceLocations": [
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            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633761681",
            "country_code": "US",
            "telephone_number": "636-939-4820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12855 N Forty Dr",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "63141",
            "country_code": "US",
            "telephone_number": "314-880-6100",
            "fax_number": "314-997-3248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
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            "address_purpose": "LOCATION",
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            "postal_code": "606412808",
            "country_code": "US",
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            "fax_number": "312-921-0397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABER",
        "first_name": "MARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R9F84",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "R9F84",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036062673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202265807",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtaber19907@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mtaber19907@direct-ehr-ssmhc.com",
            "address_1": "12855 N Forty Dr",
            "address_2": "Suite 300",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63141",
            "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": "1520 Wentzville Pkwy",
            "city": "Wentzville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633853408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "5401 Veterans Memorial Pkwy Ste 101",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633761681",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtaber19907@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mtaber19907@direct-ehr-ssmhc.com",
            "address_1": "5401 Veterans Memorial Pkwy Ste 101",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633761681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wentzville, MO

Sources for this page

Verify at the official NPI Registry.