Michael Ambrose, MD is a medicare enrolled "Internal Medicine" provider in Mount Vernon, Illinois. His current practice location is
605 N 12th St, Mount Vernon, Illinois. You can reach out to his office (for appointments etc.) via phone at
(618) 241-2212.
Michael Ambrose is licensed to practice in Illinois (license number 036128279) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1538398680.
Healthcare Provider's Profile
| Full Name | Michael Ambrose |
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| Gender | Male |
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| Speciality | Internal Medicine |
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| Location | 605 N 12th St, Mount Vernon, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1538398680
- Provider Enumeration Date: 07/10/2009
- Last Update Date: 03/25/2021
Medicare PECOS Information:
- PECOS PAC ID: 2961489034
- Enrollment ID: I20040707000149
Medical Identifiers
Medical identifiers for Michael Ambrose such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1538398680 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | 038010043 (Illinois) | Secondary |
| 208M00000X | Hospitalist | 036128279 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036128279 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Michael Ambrose allows following entities to bill medicare on his behalf.
| Provider Name | Granite City Hospitalist Services Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1669926424
PECOS PAC ID: 8527356591
Enrollment ID: O20161006000282 |
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| Provider Name | Midwest Emergency Anderson Health Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1710647615
PECOS PAC ID: 8022401256
Enrollment ID: O20220210000357 |
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| Provider Name | Midwest Inpatient Anderson Health Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1821758608
PECOS PAC ID: 3072908474
Enrollment ID: O20220322002045 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Michael Ambrose is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Michael Ambrose, MD
5036 N Illinois St Ste 1,
Fairview Heights, IL 62208-3418
Ph: (618) 671-6800 | Michael Ambrose, MD
605 N 12th St,
Mount Vernon, IL 62864
Ph: (618) 241-2212 |
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