Active NPI
Mark Maccollom Morris, DO, FACOP
- Pediatrics Physician
- Springfield, NJ
National Provider Identifier
1851390199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MB07847900
- Practice address
- 26 Millburn Ave
Springfield, NJ 07081-1071 - Phone
- (973) 258-1776
- NPI assigned
- Jul 19, 2005
- 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 |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | 25MB07847900 | NJ | |
| Pediatrics Physician | 208000000X | 25MB07847900 | NJ | Primary |
Addresses
Primary practice location
26 Millburn Ave
Springfield, NJ 07081-1071
Mailing address
26 Millburn Ave
Springfield, NJ 07081-1071
Phone (973) 258-1776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 9, 2010 through Dec 9, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB07847900 | NJ | MD | Neuromusculoskeletal Medicine & OMM Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371081600000",
"number": "1851390199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 MILLBURN AVE",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070811071",
"telephone_number": "973-258-1776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 MILLBURN AVE",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070811071",
"telephone_number": "973-258-1776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORRIS",
"first_name": "MARK",
"middle_name": "MACCOLLOM",
"credential": "DO, FACOP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2013-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "204D00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "NJ",
"license": "25MB07847900",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MB07847900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.