NPIMap

Organization Active NPI

Marcotte Medical Group, PC

Doing business as Marcotte Medical Group, SC

  • Family Medicine Physician
  • Dyer, IN
National Provider Identifier
1669424768
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARCOTTE MEDICAL GROUP, PC
Doing business as
Marcotte Medical Group, SC
Practice address
15900 W 101St Ave
Dyer, IN 46311
Phone
(219) 365-6333
Fax
(219) 365-8291
NPI assigned
May 17, 2006
Last updated
Nov 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Mr. Trevor M Marcotte, DO
Title
Owner
Phone
(219) 365-6333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X IN Primary

Addresses

Primary practice location

15900 W 101St Ave
Dyer, IN 46311

Mailing address

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

Other practice location 1

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

Other identifiers 4

IdentifierTypeStateIssuer
000000363441OtherINANTHEM
9932077OtherILBCBS
200424880AMedicaidIN
5913390001OtherINDMERC

Other names 2

  • Marcotte Medical Group, SC Doing business as
  • Marcotte Medical Group INC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041018000973 IN Part B Supplier - Clinic/Group Practice 2769453166 Receives reassigned benefits from 11 practitioners
Practice locations: Dyer, IN
O20100930010800 IN DME Supplier - Physician - Osteopathic Manipulative Medicine 2769453166 Practice locations: Dyer, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D1053373Marcotte Medical Group SC15900 W 101St Ave, Dyer, IN 46311Certificate of waiverApr 20, 2028
15D2050329Marcotte Medical Group PC16000 W 101St Ave, Dyer, IN 46311ComplianceMar 11, 2028

National Provider Directory

National Provider Directory

Locations

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBFGAA

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1669424768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "MARCOTTE MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "MARCOTTE",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-365-6333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000363441",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9932077",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200424880A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "5913390001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marcotte Medical Group, SC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marcotte Medical Group, SC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marcotte Medical Group INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Dyer, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.