Mark Blomberg, D.O.
Individual provider Active NPI Family Medicine Physician · Durand, IL
NPI 1801336995 · NPPES record last updated Dec 18, 2020
Key facts
- NPI
- 1801336995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 71267 (WI)
- Practice address
- 400 S Center St
Durand, IL 61024-9590 - Phone
- (815) 248-3443
- NPI assigned
- Mar 8, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 6
Medicare Care Compare profile
- 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.
Practice addresses (Care Compare)
400 S Ctr St
Durand, IL 61024-9590
Phone (815) 248-3443
515 22ND Ave
Monroe, WI 53566-1569
Phone (608) 324-2000
Hospital & facility affiliations
- Tri-State Home Healthcare, LLC
- SSM Health at Home Monroe
- SSM Health at Home Monroe
- The Monroe Clinic
- Uw Health
- Medina Nursing Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 13 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200817001839 | WI | Practitioner - Family Practice | 2769753037 | Reassigns benefits to 1 organization |
| I20200817001908 | IL | Practitioner - Family Practice | 2769753037 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71267 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Monroe Clinic, Inc. | Family Medicine | Current |
Accepting new patients |
Locations
400 S Center St
Durand, IL 61024
Phone (815) 248-3443
1301 Kiwanis Dr
Freeport, IL 61032
Phone (815) 235-1406
214 N Schuyler St
Lena, IL 61048
Phone (815) 369-4541
2009 5th St
Monroe, WI 53566
Phone (608) 324-1454
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
Interoperability endpoints
- mblomberg400429@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 71267 | WI | Yes |
Addresses
Primary practice location
400 S Center St
Durand, IL 61024-9590
Mailing address
515 22ND Ave
Monroe, WI 53566-1569
Phone (608) 324-1518
Other practice location 1
515 22nd Ave
Monroe, WI 53566-1569
Phone (608) 324-1518
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | mblomberg9140@direct.monroeclinic.org | Direct |
Other providers in Durand, IL
- Kiley Beck
- Mary Grace De Zee
- Trevor Deppe
- Durand Cusd 322
- Durand Family Chiropractic LLC
- Durand Telepharmacy Inc
All providers in Durand, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.