MARIO G. MASSULLO D.O. – NPI #1043228158
Internal Medicine

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Health Care Provider Taxonomy Code for Internal Medicine

MARIO MASSULLO is a physician located in KANKAKEE, IL. NPPES has assigned the NPI number 1043228158 to MARIO MASSULLO on August 04, 2006. It is a Type-1 NPI, indicating this NPI number is associated with an individual. According to the NPI Registry, there are 2 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RC0000X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Cardiovascular Disease

The NPI profile was previously updated about 5 years ago on Oct 27, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MARIO MASSULLO below.

NPI Profile for
MARIO G. MASSULLO

NPI Number
1043228158
Enumeration Date

(about 20 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
MARIO G. MASSULLO
Credentials
D.O.
Primary location
1710 W. COURT ST.
KANKAKEE, IL 60901
Phone: (815) 936-3200 Fax: (815) 936-3203
2 Other location(s):
100 Provena Way Ste C
Bourbonnais, IL 60914-4798
Phone: (815) 936-3200
Fax: (815) 936-3203
3800 W 203rd St Ste 202
Olympia Fields, IL 60461-1185
Phone: (708) 852-2699
Fax: (708) 679-2223
Mailing address
1710 W COURT ST
KANKAKEE, IL 60901-3160
Phone: (815) 936-3200 Fax:
Sole Proprietor
Yes
Updated
Certification Date
Oct 27, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for MARIO MASSULLO

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDIL036082059
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RC0000X
- Internal Medicine / Cardiovascular Disease (Primary)		 IL 036082059
207RI0011X
- Internal Medicine / Interventional Cardiology		 IL 036082059
207R00000X
- Internal Medicine		 IL 036082059

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
[email protected]
Endpoint type
Direct Messaging Address
Endpoint Description
Content Type
Affiliation
N
Endpoint Location
3800 W 203RD ST STE 202,
OLYMPIA FIELDS, IL 77025-1669

Additional Information

Education
OHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE - Graduated 1988
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
MARIO MASSULLO is affiliated with the following medical group(s):
  • HOSPITAL
    • PRESENCE ST MARYS HOSPITAL
      500 W COURT ST
      KANKAKEE, IL 60901
    • RIVERSIDE MEDICAL CENTER
      350 N WALL ST
      KANKAKEE, IL 60901

Why is my NPI data (personal information) being displayed publicly?
If you have an active NPI profile, your profile is required to be disclosed according to the FOIA and eFOIA. HIPAA also requires covered providers to share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

How do I correct or change the NPI data displayed here?
At any time, providers can make changes to their NPI profile at NPPES. Login to NPPES to make changes online or call (800) 465-3203 for assistance. Changes made at NPPES will be reflected on this web site within a few days.

Can I hide my NPI profile from the public?
Unfortunately, No. The NPPES discloses health care provider data under the Freedom of Information Act to the public, which means anyone may request such information directly from the National Plan & Provider Enumeration System. See the complete CMS Data Dissemination Notice here.