Physician Compare National (NPI:1841276847)

HEALTHCARE PROVIDER: MARK E MASS MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1841276847
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850580291
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110114001063
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MASS
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	EDWARD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MASS MEDICAL SC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4082848460
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1025 W EVERETT RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	LAKE FOREST
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600452697
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8472347950
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140242
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140130
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHWESTERN LAKE FOREST HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y