Marc R. Dejong, MD
Individual provider Active NPI Sports Medicine (Internal Medicine) Physician · Springfield, IL
NPI 1477549541 · NPPES record last updated May 22, 2020
Key facts
- NPI
- 1477549541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Internal Medicine) Physician 207RS0010X
- License
- 036114259 (IL)
- Practice address
- 800 N 1St St
Springfield, IL 62702-3719 - Phone
- (217) 528-7541
- Fax
- (217) 527-1103
- NPI assigned
- Sep 23, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 5
Medicare Care Compare profile
- Specialty
- Sports Medicine
- Education
- Vanderbilt University School of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Springfield Clinic, LLP
Practice addresses (Care Compare)
800 N 1St St
Springfield, IL 62702-3719
Phone (217) 528-7541
Hospital & facility affiliations
- Memorial Medical Center
- 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 | Jan 1, 2017 |
| Springfield Clinic Nokomis Rural Health |
Rural health clinic | Limited Partnership Interest | Jan 1, 2017 |
| Springfield Clinic Raymond Rural Health |
Rural health clinic | Limited Partnership Interest | Jan 1, 2017 |
| Springfield Clinic Neoga Rural Health |
Rural health clinic | Limited Partnership Interest | Jan 1, 2017 |
| Springfield Clinic, LLP |
Rural health clinic | Limited Partnership Interest | Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051011001142 | IL | Practitioner - Sports Medicine |
2163447822 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036114259 | IL | MD | Sports Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Clinic, LLP | Current |
Accepting new patients |
Locations
15 Founders Ln
Jacksonville, IL 62650
Phone (217) 243-0300
800 N 1st St
Fl 1
Springfield, IL 62702
800 N 1st St
Springfield, IL 62702
1025 S 6th St
Springfield, IL 62703
775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300
Interoperability endpoints
- marc.dejong.1@28977.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036114259 | IL | |
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | 036114259 | IL | Yes |
Addresses
Primary practice location
800 N 1St St
Springfield, IL 62702-3719
Mailing address
1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036114259 | Medicaid | IL |
Other providers in Springfield, IL
- Kenneth Gene Deeke
- Chad Joseph Defrain
- Quinlan Mae Degroot
- Keelan C. Dehart
- Elizabeth Deitemyer
- Jonathan E. Dela Cruz
- Marthe K.P. Dela Cruz
- Olivia Ann Delay
- Diane Deleonardo
- Mia Elise Delgado
All providers in Springfield, IL · Sports Medicine (Internal Medicine) 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 May 22, 2020. 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.