ADVANCED CARDIOVASCULAR SERVICES (NPI# 1447454657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447454657 |
| Entity Type | Organization |
| Organization Name | ADVANCED CARDIOVASCULAR SERVICES |
| Other Organization Name | DR. MARIO MASSULLO |
| Practice Address |
455 W. Court St. Suite 202 Kankakee IL 60441 |
| Mailing Address |
Po Box 882 Kankakee IL 60901-0882 |
| Practice Telephone | 8059363200 |
| Practice Fax Number | 8159363203 |
| Mailing Telephone | 8159363200 |
| Mailing Fax Number | 8159363203 |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2008-06-12 |
| Authorized Official Name | MRS. PAT DEVRIES (BILLING MANAGER) |
| Authorized Official Telephone | 7084605000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 0004632018 | 01 |
| IL | 036082059 | 05 | |
| IL | RAILROAD MEDICARE | P00059541 | 01 |
| Other Name | Type Code |
|---|---|
| Dr. Mario Massullo | Doing Business As Name - Organization |
| Street Address |
455 W. COURT ST. SUITE 202 |
| City | KANKAKEE |
| State | IL |
| Zip Code | 60441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689622250 | Joseph A Meisenbach | Internal Medicine | 455 W. Court St., Suite 202, Kankakee, IL 60901-3693 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366951840 | Samantha Jo Gehrig | Counselor | 16504 W 146th Pl, Lockport, IL 60441 | 2017-09-27 |
| 1275939415 | Walid Habbal | Dentist | 12612 S. Harlem Ave, Palos Heights, IL 60441 | 2014-11-17 |
| 1205240975 | Angelica Wujcik | Chiropractor | 420 Summit Drive, Lockport, IL 60441 | 2014-06-20 |
| 1720418916 | Melissa Obrien | Dietitian, Registered | 16221 W 159th St Ste 102, Lockport, IL 60441 | 2013-11-25 |
| 1033467535 | Trinity Services Inc. | Clinic/Center | 1017 S State St., Lockport, IL 60441 | 2012-08-15 |
| 1013219427 | Christopher David Baran | Nurse Anesthetist, Certified Registered | 1114 East Treeline Drive, Lockport, IL 60441 | 2010-11-18 |
| 1871736868 | Advanced Family Dental & Chiropractic of Lockport PC | Dentist | 730 South Washington St, Lockport, IL 60441 | 2009-04-07 |
| 1922292432 | Wal-mart Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 16241 South Farrell Rd, Lockport, IL 60441 | 2007-08-29 |
| 1407979438 | Joanne Adel Nasra | Developmental Therapist | 16136 Bent Grass Drive, Lockport, IL 60441 | 2007-04-06 |
| 1497800536 | Patrick Francis Healy | Dentist | 916 7th St, Lockport, IL 60441 | 2007-01-25 |
| Find all providers in zip 60441 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| 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. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124314349 | Gaurang Gujarathi | Internal Medicine | 1710 W Court St, Kankakee, IL 60901 | 2011-06-27 |
| 1487679205 | Vijay M Haryani | Internal Medicine | 500 N Wall St Ste C100, Kankakee, IL 60901-2942 | 2006-07-13 |
| 1316289077 | Tarun Jain | Internal Medicine | 500 N Wall St Ste C100, Kankakee, IL 60901-2942 | 2013-03-20 |
| 1588911333 | Shiva Prasad Shashidharan | Internal Medicine | 500 N Wall St, Kankakee, IL 60901 | 2012-08-11 |
| 1336339381 | Abhimanyu Beri | Internal Medicine | 500 N Wall St, Kankakee, IL 60901-2942 | 2007-07-26 |
| 1881729853 | Philip G Hays Md Sc | Internal Medicine | 400 N Wall St Ste 303, Kankakee, IL 60901-2964 | 2007-02-22 |
| 1013099225 | Vijay M. Haryani, Md, Sc | Internal Medicine | 375 N Wall St, Suite 310, Kankakee, IL 60901-3483 | 2006-10-19 |
| 1275540536 | Philip G Hays | Internal Medicine | 400 N Wall St Ste 303, Kankakee, IL 60901-2964 | 2006-08-01 |
| 1013962182 | Lynn G Brown | Internal Medicine | 500 N Wall St, Kankakee, IL 60901-2942 | 2006-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528596350 | Stat Cardiologist Inc | Internal Medicine | 2425 W 22nd St Ste 209, Oak Brook, IL 60523-4655 | 2017-05-24 |
| 1306296074 | Safwan Gaznabi | Internal Medicine | Northshore University Healthsystem, Office of Academic Affairs 2650 Ridge Ave., Suite 1304, Evanston, IL 60201 | 2016-06-14 |
| 1154796290 | Ray Jean Pensinger | Internal Medicine | 105 S. Fleming Rd., Woodstock, IL 60098-7903 | 2015-12-01 |
| 1073905311 | Cardio Medical Center Sc | Internal Medicine | 7746 West Madison Ave, Forrest Park, IL 60131 | 2015-02-24 |
| 1427457399 | Charles Joseph Frahm | Internal Medicine | 1200 E Madison Park, Chicago, IL 60615-2961 | 2014-08-17 |
| 1225447725 | Jeremy R. Estrada | Internal Medicine | 5841 S Maryland Ave # Mc5841, Chicago, IL 60637-1447 | 2014-08-08 |
| 1285049197 | Nidhi Madan | Internal Medicine | 1717 W Congress Pkwy Ste 317, Chicago, IL 60612 | 2014-06-30 |
| 1295159184 | Ca Group, LLC | Internal Medicine | 4017 Illinois Route 159, Suite 101, Smithton, IL 62285 | 2014-02-12 |
| 1457788424 | Chicago Vascular Clinic Ltd | Internal Medicine | 812 E Woodfield Rd, Schaumburg, IL 60173-4714 | 2013-10-04 |
| 1942634688 | Vein Md Consultants, LLC | Internal Medicine | 1865 N. Eltnor Blvd., West Chicago, IL 60185-5900 | 2013-08-29 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on ADVANCED CARDIOVASCULAR SERVICES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.