NPIMap

Individual provider Active NPI

Trevor J Marcotte, DO

  • Family Medicine Physician
  • Dyer, IN
National Provider Identifier
1649224734
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02002588A Issued in IN
Practice address
15900 W 101St Ave
Dyer, IN 46311
Phone
(219) 365-6333
Fax
(219) 365-8291
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036110052 IL
Family Medicine Physician 207Q00000X 0036110052 IL
Family Medicine Physician 207Q00000X 02002588A IN Primary

Addresses

Primary practice location

15900 W 101St Ave
Dyer, IN 46311

Mailing address

15900 W 101St Ave
Marcotte Medical Group, SC
Dyer, IN 46311
Phone (219) 365-6333

Other practice location 1

16000 W 101st Ave
Dyer, IN 46311
Phone (219) 365-6333

Other identifiers 6

IdentifierTypeStateIssuer
9932077OtherILBCBS
000000363442OtherINANTHEM
200494280AMedicaidIN
036110052MedicaidIL
P00307566OtherINRAILROAD
P00158260OtherILRAILROAD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address trevor.marcotte@mmgsc.eclinicaldirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20041018000818 IN Practitioner - Family Practice 2668442195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Marcotte Medical Group PCGroup PAC ID 2769453166, 11 clinicians

Practice addresses (Care Compare)

15900 W 101St Ave
Dyer, IN 46311-3065
Phone (219) 365-6333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions29
Removal or shaving of skin growth46
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0036110052ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marcotte Medical Group, PC Family Medicine CurrentSince Jul 1, 2004 Accepting new patients

Locations

117 S Harlem Ave
Peotone, IL 60468
Phone (708) 258-6524

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

15900 W 101st Ave
Dyer, IN 46311
Phone (219) 365-6333

15900 W 101st Ave
#0
Dyer, IN 46311

Interoperability endpoints

  • Direct secure messaging: tmarcotte64270@direct.franciscanalliance.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/EBFGAA

Organizations & group practices 1

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 11

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1649224734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15900 W 101ST AVE",
            "address_2": "MARCOTTE MEDICAL GROUP, SC",
            "city": "DYER",
            "state": "IN",
            "postal_code": "46311",
            "telephone_number": "219-365-6333",
            "fax_number": "219-365-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15900 W 101ST AVE",
            "city": "DYER",
            "state": "IN",
            "postal_code": "46311",
            "telephone_number": "219-365-6333",
            "fax_number": "219-365-8291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16000 W 101st Ave",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "46311",
            "country_code": "US",
            "telephone_number": "219-365-6333",
            "fax_number": "219-365-8291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCOTTE",
        "first_name": "TREVOR",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2021-04-08",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036110052",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "0036110052",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02002588A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9932077",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000363442",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200494280A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110052",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00307566",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00158260",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "trevor.marcotte@mmgsc.eclinicaldirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "15900 W 101st Ave",
            "city": "Dyer",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dyer, IN

Sources for this page

Verify at the official NPI Registry.