| Mario Gerard Massullo, DO | |
|
1710 W. Court St., Kankakee, IL 60901 | |
| (815) 936-3200 | |
| (815) 936-3203 |
| Full Name | Mario Gerard Massullo |
|---|---|
| Gender | Male |
| Speciality | Cardiac Surgery |
| Experience | 38 Years |
| Location | 1710 W. Court St., Kankakee, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043228158 | NPI | - | NPPES |
| 036082059 | Medicaid | IL |
| Facility Name | Location | Facility Type |
|---|---|---|
| St. Mary's Hospital-kankakee | Kankakee, IL | Hospital |
| Iroquois Memorial Hospital | Watseka, IL | Hospital |
| Riverside Medical Center | Kankakee, IL | Hospital |
| The Carle Foundation Hospital | Urbana, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Prime Healthcare Illinois Medical Group Llc | 5597275685 | 278 |
| Entity Name | Specialty Physicians of Illinois LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1124075676 PECOS PAC ID: 4183529456 Enrollment ID: O20031201000602 |
| Entity Name | Prime Healthcare Illinois Medical Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023837689 PECOS PAC ID: 5597275685 Enrollment ID: O20250609000646 |
| Mailing Address | Practice Location Address |
|---|---|
| Mario Gerard Massullo, DO 1710 W Court St, Kankakee, IL 60901-3160 Ph: (815) 936-3200 | Mario Gerard Massullo, DO 1710 W. Court St., Kankakee, IL 60901 Ph: (815) 936-3200 |
Dr. Martin T Phillips, MD Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 555 W Court St, Suite 108, Kankakee, IL 60901 Phone: 888-220-6432 Fax: 630-654-4253 |
Dr. Raju Zachariah Abraham, MD Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 500 N Wall St Ste C400, Kankakee, IL 60901 Phone: 815-933-3814 Fax: 815-933-3846 |
Dr. Lynn G Brown, MD Cardiovascular Disease Medicare: Medicare Enrolled Practice Location: 500 N Wall St, Kankakee, IL 60901 Phone: 844-404-4787 Fax: 815-936-3243 |
Dr. Samrat Umesh Khanna, MD Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 500 N Wall St Ste C400, Kankakee, IL 60901 Phone: 815-933-3814 Fax: 815-933-3846 |
Dr. Rahul Patel, Cardiovascular Disease Medicare: Not Enrolled in Medicare Practice Location: 350 N Wall St, Kankakee, IL 60901 Phone: 815-933-1671 |
James Choi, DO Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 375 N Wall St Ste P410, Kankakee, IL 60901 Phone: 815-933-3814 |
Lisa Patel, MD Cardiovascular Disease Medicare: Medicare Enrolled Practice Location: 401 N Wall St Ste 102, Kankakee, IL 60901 Phone: 815-928-5090 Fax: 815-928-5079 |