Mark Edward Cormier, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036080935 Issued in IL

Practice address

351 Executive Pkwy
Rockford, IL 61107-5339

Phone

(815) 398-4057

Fax

(815) 398-0220

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• United Shockwave Services, LTD.

  • Ambulatory Surgical Clinic/Center
  • La Grange, IL
  • NPI 1336526219
  NPD
• United Shockwave Services, LTD.

  • Urology Physician
  • Park Ridge, IL
  • NPI 1497132377
  NPD

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1922078401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 EXECUTIVE PKWY",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075339",
            "telephone_number": "815-398-4057",
            "fax_number": "815-398-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 EXECUTIVE PKWY",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075339",
            "telephone_number": "815-398-4057",
            "fax_number": "815-398-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORMIER",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036080935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036080935",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorie Anne Corcoran, APNP
• Flavio Cordano, DPM
• Kristin Cordell
• Samantha Corey
• Clayton A. Corless, ATC
• Ashley C Cornell
• Cornerstone Clinic, LTD.
• Daniel Corredor, MD
• Nicole M Correnti, MPT
• Debra Corrigan, APN

• Urology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.