NPIMap

Individual provider Active NPI

Victor Mwansa, M.D

  • Interventional Cardiology Physician
  • Marion, IL
National Provider Identifier
1811194244
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
36118765 Issued in IL
Practice address
3331 W Deyoung St
Suite 100
Marion, IL 62959-5896
Phone
(618) 998-7600
Fax
(618) 997-6680
NPI assigned
Jun 29, 2007
Last updated
Dec 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036118765 IL
Interventional Cardiology Physician 207RI0011X 36118765 IL Primary

Addresses

Primary practice location

3331 W Deyoung St
Suite 100
Marion, IL 62959-5896

Mailing address

3331 W Deyoung St
Suite 100
Marion, IL 62959-5896
Phone (618) 998-7600

Other identifiers 1

IdentifierTypeStateIssuer
036118765MedicaidIL

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
I20120808000389 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 1254587116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3331 W Deyoung St
Marion, IL 62959-5896
Phone (618) 998-7600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.56 of 100Reported as individual
Quality
64.99
Promoting interoperability
96
Improvement activities
40
Cost
55.61

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting73
Pacemaker insertion or repair25
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36118765ILMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Cardiovascular Disease Current Accepting new patients
Deaconess Illinois Clinic, Inc Past Accepting new patients

Locations

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

3331 W Deyoung St
Marion, IL 62959
Phone (618) 985-9140

3331 W Deyoung St
Ste 100
Marion, IL 62959
Phone (618) 998-7600

3331 W Deyoung St
Ste 203
Marion, IL 62959
Phone (618) 997-4733

3331 W Deyoung St
Ste 305
Marion, IL 62959
Phone (618) 998-7089

209 Crossroads Pl
Mount Vernon, IL 62864
Phone (618) 242-4554

Interoperability endpoints

  • Direct secure messaging: victor.mwansa.1@27782.direct.athenahealth.com
  • Direct secure messaging: vmwansa@yourcarecommunity.org
  • Direct secure messaging: vmwansa423978@direct.deaconess.com

Organizations & group practices 4

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1811194244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST",
            "address_2": "SUITE 100",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-998-7600",
            "fax_number": "618-997-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST",
            "address_2": "SUITE 100",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-998-7600",
            "fax_number": "618-997-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWANSA",
        "first_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2023-12-11",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036118765",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "36118765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036118765",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.