Mark Jay McGillem, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

01051194A Issued in IN

Practice address

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469

Phone

(574) 335-2521

Fax

(574) 335-2262

NPI assigned

Nov 2, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331769600000",
    "number": "1700877339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-2521",
            "fax_number": "574-335-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGILLEM",
        "first_name": "MARK",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01051194A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000735776",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200233400",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adalynn Danette McCullough, M.A. CCC-SLP
• Avery Antonio McCully
• Carolyn McDonald, CNM
• Wanda Ann McFadden, LCSW
• Tianna McGee
• Brooke J McIntyre, MA, LMHC
• McKinley Family Dental
• McKinley Medical Clinmic
• Melissa Rose McKinney
• Joyce M McMahon Palmateer, FNP

• Internal Medicine Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; 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.