Brian Wade Mecklenburg, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036.149788 Issued in IL

Practice address

2202 Harlem Road
Suite 200
Loves Park, IL 61111-2754

Phone

(815) 877-4848

Fax

(815) 654-3271

NPI assigned

Feb 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Georgetown University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rockford Anesthesiologists Associated LLCGroup PAC ID 5597668004, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uw Health Hospital, Rockford, IL, CCN 140228
• FHN Memorial Hospital Hospital, Freeport, IL, CCN 140160

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rockford Anesthesiologists Associated, L.L.C.

  • Anesthesiology Physician
  • Loves Park, IL
  • NPI 1639128598
  Medicare reassignment Care Compare group NPD
• Rockford Anesthesiologists Associated, L.L.C.

  • Certified Registered Nurse Anesthetist
  • Loves Park, IL
  • NPI 1629090642
  NPD (past)

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

• Freeport Memorial Hospital

  dba FHN-Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  Care Compare affiliation
• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732
  Care Compare affiliation

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1912047085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 HARLEM ROAD",
            "address_2": "SUITE 200",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848",
            "fax_number": "815-654-3271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 HARLEM ROAD",
            "address_2": "SUITE 200",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848",
            "fax_number": "815-654-3271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MECKLENBURG",
        "first_name": "BRIAN",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "VA",
            "license": "0101102755",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036.149788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036149788",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Omar Jesse McKenzie, MD
• Kathleen M Meade
• Medical Resource Center LTD
• Dipsa Merchant
• Metro Medical Services Inc
• Scott A Meyers, RPH
• Midway EMS

• Anesthesiology Physician in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.