Marissa Jane Versalle, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036146901 Issued in IL

Practice address

990 S Waukegan Rd FL 2
Lake Forest, IL 60045-2654

Phone

(847) 861-0025

Fax

(847) 861-0026

NPI assigned

Apr 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

HospitalistAlso: Internal Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Forward Focus Medical Care LLCGroup PAC ID 2961402482, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
• Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Merit-based Incentive Payment System (MIPS)

Final score

95.19 of 100Reported as apm

Quality

83.05

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Forward Focus Medical Care LLC

  • Internal Medicine Physician
  • Lake Forest, IL
  • NPI 1245314616
  Medicare reassignment Care Compare group
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Endeavor Health Clinical Operations

  • General Acute Care Hospital
  • Evanston, IL
  • NPI 1184670549
  Care Compare affiliation
• Northwestern Lake Forest Hospital

  • General Acute Care Hospital
  • Lake Forest, IL
  • NPI 1124025176
  Care Compare affiliation
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1669891107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 S WAUKEGAN RD STE 200",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452654",
            "telephone_number": "847-234-8100",
            "fax_number": "847-234-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 S WAUKEGAN RD FL 2",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452654",
            "telephone_number": "847-861-0025",
            "fax_number": "847-861-0026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 N Westmoreland Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Forest",
            "state": "IL",
            "postal_code": "60045",
            "country_code": "US",
            "telephone_number": "847-234-5600",
            "fax_number": "847-535-7203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERSALLE",
        "first_name": "MARISSA",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036.146901",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "34.012714",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036146901",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lynn Valentine, DPT, OCS
• Shiney J. Varghese, DNP, FNP-BC
• Katina C Venetos, MD
• Tanya Rose Verdoljak, M.A., CCC-SLP
• Denise Verges, MD
• Victoria Kut MD LTD
• David Vigder, MD
• Mariana Vigiola Cruz, MD
• Michael P Viglione, MD PHD
• Courtney Keene Viscomi, PSYD, BCBA

• Internal Medicine Physician in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; 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.
• 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.