NPIMap

Individual provider Active NPI

Mark A Wargo, M.D.

  • Family Medicine Physician
  • Streator, IL
National Provider Identifier
1457304156
Registry record updated Jun 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036099987 Issued in IL
Practice address
109 E Elm St
Streator, IL 61364-2223
Phone
(815) 672-4587
Fax
(815) 673-3582
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036099987 IL Primary

Addresses

Primary practice location

109 E Elm St
Streator, IL 61364-2223

Mailing address

109 E Elm St
Streator, IL 61364-2223
Phone (815) 672-4587

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
I20100824000234 IL Practitioner - Family Practice 2264599687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint James HospitalGroup PAC ID 0648187252, shared by 14 NPIs, 74 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

111 Spring St
FL 4
Streator, IL 61364-3332
Phone (815) 672-4587

124 SW Adams St
Peoria, IL 61602-1308

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Saint James Hospital Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 4

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 8

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1457304156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 E ELM ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642223",
            "telephone_number": "815-672-4587",
            "fax_number": "815-673-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E ELM ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642223",
            "telephone_number": "815-672-4587",
            "fax_number": "815-673-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARGO",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036099987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Streator, IL

Sources for this page

Verify at the official NPI Registry.