Mark Brian Colander, O.D,
Individual provider Active NPI Optometrist · Worth, IL
NPI 1871889196 · NPPES record last updated Sep 14, 2013
Key facts
- NPI
- 1871889196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046010615 (IL)
- Practice address
- 11412 S Harlem Ave
Worth, IL 60482-2004 - Phone
- (708) 422-7000
- Fax
- (708) 448-4295
- NPI assigned
- Jun 24, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
11412 S Harlem Ave
Worth, IL 60482-2004
Phone (708) 422-7000
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 16 |
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: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121012000709 | IL | Practitioner - Optometry | 4688823354 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beloved Community Family Wellness Center | Current |
Accepting new patients | |
| Beloved Community Family Wellness Center | Current | Accepting new patients | |
| Beloved Community Family Wellness Center | Current |
Accepting new patients | |
| J. a. Nolan, OD LTD | Optometrist | Past |
Accepting new patients |
Locations
2338 New St
Blue Island, IL 60406
Phone (708) 577-5060
326 W 64th St
Ste 205
Chicago, IL 60621
Phone (773) 651-3629
6821 S Halsted St
Chicago, IL 60621
Phone (773) 651-3629
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010615 | IL | Yes |
| Optometrist | 152W00000X | 18003760A | IN |
Addresses
Primary practice location
11412 S Harlem Ave
Worth, IL 60482-2004
Mailing address
11412 S Harlem Ave
Worth, IL 60482-2004
Phone (708) 422-7000
Other providers in Worth, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2013. 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.