NPIMap

Individual provider Active NPI

Mark Vexelman, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1700896750
Registry record updated Aug 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036095873 Issued in IL
Practice address
150 E Huron Street
Suite 805
Chicago, IL 60611-2912
Phone
(312) 649-6565
Fax
(312) 649-9842
NPI assigned
Aug 9, 2006
Last updated
Aug 21, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036095873 IL Primary

Addresses

Primary practice location

150 E Huron Street
Suite 805
Chicago, IL 60611-2912

Mailing address

150 E Huron Street
Suite 805
Chicago, IL 60611-2912
Phone (312) 649-6565

Other identifiers 1

IdentifierTypeStateIssuer
036095873MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040108000997 IL Practitioner - Internal Medicine 5496654386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2900 N Lake Shore Dr
Chicago, IL 60657-5640
Phone (773) 665-3000

5050 Touhy Ave
Skokie, IL 60077-3542
Phone (847) 679-6100

5140 N California Ave
Chicago, IL 60625-3645
Phone (773) 878-8200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.95 of 100Reported as individual
Quality
94.61
Improvement activities
40
Cost
70.22

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue22
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036095873ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Shore Adult & Geriatric Medicine, LTD Family Medicine CurrentSince Mar 29, 2004 Accepting new patients

Locations

150 E Huron St
Ste 805
Chicago, IL 60611
Phone (312) 649-6565

233 E Erie St
Ste 302
Chicago, IL 60611
Phone (312) 649-6565

4340 N Keystone Ave
Chicago, IL 60641
Phone (773) 545-8700

5050 Touhy Ave
Skokie, IL 60077
Phone (847) 679-6100

Interoperability endpoints

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Dobson PlazaEvanston, IL, CCN 145122 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2022
Jan 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1700896750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E HURON STREET",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112912",
            "telephone_number": "312-649-6565",
            "fax_number": "312-649-9842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E HURON STREET",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112912",
            "telephone_number": "312-649-6565",
            "fax_number": "312-649-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEXELMAN",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036095873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095873",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.