Mark Blomberg, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

71267 Issued in WI

Practice address

400 S Center St
Durand, IL 61024-9590

Phone

(815) 248-3443

NPI assigned

Mar 8, 2017

Last updated

Dec 18, 2020By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

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 2

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Monroe Clinic, Inc.Group PAC ID 3072425495, 199 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tri-State Home Healthcare, LLC Home health agency, Freeport, IL, CCN 148365
• SSM Health at Home Monroe Home health agency, Monroe, WI, CCN 527157
• SSM Health at Home Monroe Hospice, Monroe, WI, CCN 521523
• The Monroe Clinic Hospital, Monroe, WI, CCN 520028
• Uw Health Hospital, Rockford, IL, CCN 140228
• Medina Nursing Center Nursing home, Durand, IL, CCN 145495

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mblomberg400429@direct-ehr-ssmhc.com
• Direct secure messaging: mblomberg9140@direct.monroeclinic.org

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.

• The Monroe Clinic, Inc.

  dba Monroe Clinic physician group Illinois medicare

  • Family Medicine Physician
  • Freeport, IL
  • NPI 1831254036
  Medicare reassignment Care Compare group NPD
• The Monroe Clinic, Inc.

  dba SSM Health Monroe Clinic Medical Group

  • Specialist
  • Monroe, WI
  • NPI 1386720548
  Medicare reassignment

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

• Medina Nursing Center, Inc

  • Skilled Nursing Facility
  • Durand, IL
  • NPI 1720055809

  Nursing home

  Care Compare affiliation
• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732
  Care Compare affiliation
• Tri-State Home Healthcare, LLC

  dba Tri-State Home HealthCare

  • Home Health Agency
  • Freeport, IL
  • NPI 1154663995
  Care Compare affiliation
• The Monroe Clinic, Inc.

  dba SSM Health At Home HomeHealth Monroe

  • Home Health Agency
  • Monroe, WI
  • NPI 1295830628
  Care Compare affiliation
• The Monroe Clinic, Inc.

  dba SSM Health Monroe Hospital

  • General Acute Care Hospital
  • Monroe, WI
  • NPI 1740291491
  Care Compare affiliation
• The Monroe Clinic, Inc.

  • Community Based Hospice Care Agency
  • Monroe, WI
  • NPI 1932204211
  Care Compare affiliation

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1801336995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 22ND AVE",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535661569",
            "telephone_number": "608-324-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S CENTER ST",
            "city": "DURAND",
            "state": "IL",
            "postal_code": "610249590",
            "telephone_number": "815-248-3443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "WI",
            "postal_code": "535661569",
            "country_code": "US",
            "telephone_number": "608-324-1518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOMBERG",
        "first_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-08",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "71267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "400 S Center St",
            "city": "Durand",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610249590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mblomberg9140@direct.monroeclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mblomberg9140@direct.monroeclinic.org",
            "address_1": "400 S Center St",
            "city": "Durand",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610249590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kiley Beck, CF-SLP
• Mary Grace De Zee, P.T.
• Trevor Deppe, D.C., ATC
• Durand Cusd 322
• Durand Family Chiropractic LLC
• Durand Telepharmacy Inc

• Family Medicine Physician in Durand, IL
• Providers in Durand, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.