Active NPI
Mark T Klucka, D.O.
- Family Medicine Physician
- Alton, IL
National Provider Identifier
1801902432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036077227
- Practice address
- 4 Memorial Dr Ste 230
Alton, IL 62002-6704 - Phone
- (618) 463-7874
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036077227 | IL | Primary |
| Gastroenterology Physician | 207RG0100X | 036.077227 | IL |
Addresses
Primary practice location
4 Memorial Dr Ste 230
Alton, IL 62002-6704
Mailing address
PO Box 959203
Saint Louis, MO 63195-1281
Phone (618) 463-7874
Other practice location 1
2 Saint Anthonys Way
Suite 305
Alton, IL 62002-4569
Phone (618) 465-2761
Other practice location 2
3 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone (618) 641-5803
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036077227 | Medicaid | IL | |
| 100013015 | Other | IL | RAILROAD MEDICARE |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mklucka215144@ewd.direct.hshs.org | Direct | |
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- 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
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of North Texas HSC, College of Osteopathic Med, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.81 of 100
- Quality
- 85.98
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 92.87
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 85 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 90 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036077227 | IL | MD | Family Medicine Physician |
| 036.077227 | IL | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Heights Medical Group SC | Current | Accepting new patients | |
| Fairview Heights Medical Group SC | Current | Accepting new patients |
Locations
1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240
4 Memorial Dr
Ste 230
Alton, IL 62002
Phone (618) 463-7874
Interoperability endpoints
- mklucka215144@ewd.direct.hshs.org
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1073022000
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Alton, IL
- NPI 1548278476
-
- General Acute Care Hospital
- Belleville, IL
- NPI 1982796181
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1649299827
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1639186760
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758240000000",
"number": "1801902432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 959203",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631951281",
"telephone_number": "618-463-7874",
"fax_number": "618-463-7846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 MEMORIAL DR STE 230",
"city": "ALTON",
"state": "IL",
"postal_code": "620026704",
"telephone_number": "618-463-7874"
}
],
"practiceLocations": [
{
"address_1": "2 Saint Anthonys Way",
"address_2": "Suite 305",
"address_purpose": "LOCATION",
"city": "Alton",
"state": "IL",
"postal_code": "620024569",
"country_code": "US",
"telephone_number": "618-465-2761",
"fax_number": "618-465-4750",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3 Saint Elizabeth Blvd",
"address_purpose": "LOCATION",
"city": "O Fallon",
"state": "IL",
"postal_code": "62269",
"country_code": "US",
"telephone_number": "618-641-5803",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLUCKA",
"first_name": "MARK",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2025-09-19",
"certification_date": "2025-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036077227",
"primary": true
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "IL",
"license": "036.077227",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036077227",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "100013015",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mklucka215144@ewd.direct.hshs.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "3 Saint Elizabeth Blvd",
"city": "O Fallon",
"state": "IL",
"country_code": "US",
"postal_code": "62269",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "4 Memorial Dr Ste 230",
"city": "Alton",
"state": "IL",
"country_code": "US",
"postal_code": "620026704",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.