NPIMap

Individual provider Active NPI

Mark A Passerman, DO

  • Family Medicine Physician
  • Dwight, IL
National Provider Identifier
1851404313
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-116449 Issued in IL
Practice address
101 S Prairie Ave
Dwight, IL 60420
Phone
(815) 584-3291
Fax
(815) 584-3475
NPI assigned
Aug 17, 2006
Last updated
Jun 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-116449 IL Primary

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

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
I20061128000134 IL Practitioner - Family Practice 6305844457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

101 S Prairie Ave
Dwight, IL 60420-1350
Phone (815) 584-3291

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-116449ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital Family Medicine Current Accepting new patients
Morris Hospital CurrentSince Jan 29, 2010 Accepting new patients
Morris Hospital CurrentSince Jan 29, 2010 Accepting new patients
Morris Hospital 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

150 W High St
Morris, IL 60450
Phone (815) 942-2129

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: mark.passerman.1@14307.direct.athenahealth.com
  • Direct secure messaging: mark.passerman@direct-address.org

Organizations & group practices 5

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 8

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1851404313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-941-9124",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S PRAIRIE AVE",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "60420",
            "telephone_number": "815-584-3291",
            "fax_number": "815-584-3475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "389 E Main St",
            "address_purpose": "LOCATION",
            "city": "Braidwood",
            "state": "IL",
            "postal_code": "604082010",
            "country_code": "US",
            "telephone_number": "815-458-2532",
            "fax_number": "815-458-2455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSERMAN",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-116449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dwight, IL

Sources for this page

Verify at the official NPI Registry.