Individual provider Active NPI

Mark J Hsu, MD

  • Cardiovascular Disease Physician
  • Peoria, IL
National Provider Identifier
1376573428
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036-101389 Issued in IL
Practice address
5405 North Knoxville Avenue
Peoria, IL 61614
Phone
(309) 691-4410
Fax
(309) 589-2830
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036101389 IL
Cardiovascular Disease Physician 207RC0000X 036-101389 IL Primary

Addresses

Primary practice location

5405 North Knoxville Avenue
Peoria, IL 61614

Mailing address

5405 North Knoxville Avenue
Peoria, IL 61614
Phone (309) 691-4410

Other identifiers 2

IdentifierTypeStateIssuer
036-101389MedicaidIL
036101389MedicaidIL

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
I20050224000405 IL Practitioner - Cardiovascular Disease (Cardiology) 0648223131 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Medical College of Ohio, 1988
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1420 W Pioneer Pkwy
Peoria, IL 61615-1941

5405 N Knoxville Ave
Peoria, IL 61614-5016

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Graham Hospital Association Hospital, Canton, IL, CCN 140001
  • Osf Saint Luke Medical Center Hospital, Kewanee, IL, CCN 141325

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-101389ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pekin Memorial Hospital Current Accepting new patients
Pekin Memorial Hospital CurrentSince Oct 1, 2016 Accepting new patients
Graham Hospital Association CurrentSince Jun 1, 2000 Accepting new patients
Graham Hospital Association CurrentSince Jun 1, 2000 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

210 W Walnut St
Canton, IL 61520
Phone (309) 647-5240

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

Organizations & group practices 5

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 1

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281052800000",
    "number": "1376573428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 NORTH KNOXVILLE AVENUE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-691-4410",
            "fax_number": "309-589-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 NORTH KNOXVILLE AVENUE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-691-4410",
            "fax_number": "309-589-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HSU",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2010-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036101389",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036-101389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-101389",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101389",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.