Mark Ron Ibe Sr., MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.018841 Issued in IL

Practice address

6325 Main St
Woodridge, IL 60517-1357

Phone

(630) 541-6773

NPI assigned

Apr 5, 2019

Reactivated

Dec 11, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Advanced Wellness Medical, LLC

  • General Practice Physician
  • Woodridge, IL
  • NPI 1831597194
  Medicare reassignment NPD
• Pri Chicago PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Elmhurst, IL
  • NPI 1639822737
  Medicare reassignment NPD
• Premiere Anesthesia Group LLC

  • Certified Registered Nurse Anesthetist
  • Park Ridge, IL
  • NPI 1720467392
  NPD
• Pain Relief Institute, LLC

  • Physical Therapist
  • Glenview, IL
  • NPI 1003364233
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1528520665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9124 S SOMERSET LN",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605177587",
            "telephone_number": "630-699-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 MAIN ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171357",
            "telephone_number": "630-541-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBE",
        "first_name": "MARK",
        "middle_name": "RON",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "deactivation_date": "2019-07-24",
        "reactivation_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.018841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyde & Speak LLC
• Hyde & Speak PLLC
• Michelle Hyde
• Amy Beth Iacch, RN
• Julianne Marie Iandoli, PA-C
• Amanda Rose Ico, OD
• Illini Surgical Associates, Inc
• Illinois Bone and Joint Institute LLC
• Illinois Bone and Joint Institute, LLC
• Immediate Pain Care of Woodridge LLC

• Family Nurse Practitioner in Woodridge, IL
• Providers in Woodridge, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.