Mary Ludolph, MD
Individual provider Active NPI Diagnostic Radiology Physician · Springfield, IL
NPI 1376580225 · NPPES record last updated Aug 4, 2015
Key facts
- NPI
- 1376580225
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 036114091 (IL)
- Practice address
- 3050 Montvale Dr Ste a
Springfield, IL 62704-6924 - Phone
- (217) 726-8096
- NPI assigned
- Jun 1, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 24
Hospital & facility affiliations 5
Owned or controlled facilities with NPI records 5
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Springfield Clinic, LLP
Practice addresses (Care Compare)
1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541
Hospital & facility affiliations
- Memorial Medical Center
- Abraham Lincoln Memorial Hospital
- Jacksonville Memorial Hospital
- Taylorville Memorial Hospital
- St Johns Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.83 of 100
- Quality
- 75.65
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Springfield Clinic Lincoln Rural Health |
Rural health clinic | Limited Partnership Interest | Jul 1, 2021 |
| Springfield Clinic Nokomis Rural Health |
Rural health clinic | Limited Partnership Interest | Jul 1, 2021 |
| Springfield Clinic Raymond Rural Health |
Rural health clinic | Limited Partnership Interest | Jul 1, 2021 |
| Springfield Clinic Neoga Rural Health |
Rural health clinic | Limited Partnership Interest | Jul 1, 2021 |
| Springfield Clinic, LLP |
Rural health clinic | Limited Partnership Interest | Jul 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050917000449 | IL | Practitioner - Diagnostic Radiology | 8729011838 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crawford Hospital District | Current | Accepting new patients | |
| Springfield Clinic, LLP | Current |
Accepting new patients | |
| Springfield Clinic LLP | Current | Accepting new patients |
Locations
1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131
1025 S 6th St
Springfield, IL 62703
775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300
Interoperability endpoints
- mludo@yourcarecommunity.org
- maryludolph@sfc.allscriptsdirect.net
- mary.ludolph.1@28977.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 036114091 | IL | Yes |
Addresses
Primary practice location
3050 Montvale Dr Ste a
Springfield, IL 62704-6924
Mailing address
2040 W Iles Ave
Suite C
Springfield, IL 62704-4183
Phone (217) 789-0668
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036114091 | Medicaid | IL |
Other providers in Springfield, IL
- Jessica E Lucca
- Kyle Andrew Lucca
- Kelly Ann Luciano
- Deja Luckett
- Charles L Lucore
- Leo K Ludwig
- John D Luker
- Andrea M Lukert
- Luminary Counseling and Solutions, LLC
- Samantha Lund
All providers in Springfield, IL · Diagnostic Radiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.