Individual provider Active NPI

Mark D Minier, MD

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1629156559
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036137053 Issued in IL
Practice address
2001 S California Ave Ste 100
Chicago, IL 60608
Phone
(773) 584-6200
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036137053 IL Primary

Addresses

Primary practice location

2001 S California Ave Ste 100
Chicago, IL 60608

Mailing address

2001 S California Ave Ste 100
Chicago, IL 60608-2486
Phone (773) 640-5785

Other identifiers 1

IdentifierTypeStateIssuer
036137053MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mark.minier.1@11903.direct.athenahealth.com Direct

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
I20150310000620 IL Practitioner - Pediatric Medicine 7214963222 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Centers CurrentSince Jul 13, 2019 Accepting new patients
Esperanza Health Centers CurrentSince Jul 13, 2019 Accepting new patients
Esperanza Health Centers Current Accepting new patients
Esperanza Health Centers Past Accepting new patients
Howard University Pediatrics Past Accepting new patients

Locations

6550 S Richmond St
Chicago, IL 60629
Phone (773) 863-0245

2001 S California Ave
Chicago, IL 60608
Phone (773) 484-1201

4058 W 63rd St
Chicago, IL 60629
Phone (773) 432-4033

3124 W 59th St
Chicago, IL 60629
Phone (773) 776-3422

2001 S California Ave
Ste 100
Chicago, IL 60608
Phone (773) 640-5785

4700 S California Ave
Chicago, IL 60632
Phone (708) 713-0078

Interoperability endpoints

  • Direct secure messaging: mark.minier.1@11903.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/11903/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1629156559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S CALIFORNIA AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082486",
            "telephone_number": "773-640-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S CALIFORNIA AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60608",
            "telephone_number": "773-584-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINIER",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036137053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036137053",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.minier.1@11903.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2001 S California Ave Ste 100",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.