Mark A Passerman, DO
Individual provider Active NPI Family Medicine Physician · Dwight, IL
NPI 1851404313 · NPPES record last updated Jun 14, 2021
Key facts
- NPI
- 1851404313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036-116449 (IL)
- Practice address
- 101 S Prairie Ave
Dwight, IL 60420 - Phone
- (815) 584-3291
- Fax
- (815) 584-3475
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- College of Osteopathic Physicians and Surgeons of Los Angeles, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Morris Hospital
Practice addresses (Care Compare)
101 S Prairie Ave
Dwight, IL 60420-1350
Phone (815) 584-3291
Hospital & facility affiliations
- Candlelight Home Healthcare LLC
- Resilience Home Health, LLC
- At Home Quality Care - Morris
- Lightways Hospice and Serious Illness Care
- Morris Hospital & Healthcare Centers
- Riverside Medical Center
- Saint James Hospital
- Osf Saint Elizabeth MDL Ctr
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in 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 |
|---|---|---|---|---|
| I20061128000134 | IL | Practitioner - Family Practice | 6305844457 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-116449 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morris Hospital | Current | Accepting new patients | |
| Morris Hospital | Current |
Accepting new patients | |
| Morris Hospital | Current |
Accepting new patients | |
| Morris Hospital | Family Medicine | Current | Accepting new patients |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
389 E Main St
Braidwood, IL 60408
Phone (815) 458-2532
27240 W Saxony Dr
Ste 201
Channahon, IL 60410
Phone (815) 467-1518
725 School St
Ste A
Morris, IL 60450
150 W High St
Morris, IL 60450
Phone (815) 942-2129
Interoperability endpoints
- mark.passerman.1@14307.direct.athenahealth.com
- mark.passerman@direct-address.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-116449 | IL | Yes |
Addresses
Primary practice location
101 S Prairie Ave
Dwight, IL 60420
Mailing address
725 School St Ste a
Morris, IL 60450-1207
Phone (815) 941-9124
Other practice location 1
389 E Main St
Braidwood, IL 60408-2010
Phone (815) 458-2532
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036116449-1 | Medicaid | IL |
Other providers in Dwight, IL
- Laura E Lamere
- Sheryl Landstrom
- Kelly Martin
- Michael C Cichon
- Claude P Owikoti
- Saint James Hospital
- Maulin G Shah
- Louis Shicker
- Shopko Stores Operating Co LLC
- Michael Scott Smith
All providers in Dwight, 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 Jun 14, 2021. 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.