Mario Massullo, D.O.
Mario Massullo, D.O. is a Cardiovascular Disease Physician in Kankakee, IL, registered under NPI 1043228158. This provider registers 3 separate taxonomy codes, which usually means they practise across more than one recognised specialty. NPPES records them as a sole proprietor, meaning the practice is not incorporated as a separate legal entity.
Getting there
The practice address on file is 1710 W. COURT ST., Kankakee, IL 60901. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 036082059 | IL | Cardiovascular Disease Physician primary |
| 036082059 | IL | Internal Medicine Physician |
| 036082059 | IL | Interventional Cardiology Physician |
This provider holds licence 036082059 issued in IL. A licence number in NPPES reflects what was filed at registration — it does not confirm the licence is still active today.
- Status
- Approved
- Provider type
- Practitioner - Cardiac Surgery
- PAC ID
- 3577554690
- Enrollment ID
- I20040519000182
Medicare enrolment is recorded as approved under the provider type Practitioner - Cardiac Surgery. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
What Cardiovascular Disease covers
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. NUCC Health Care Provider Taxonomy, code 207RC0000X
All registered taxonomy codes
This provider registers 3 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 207RC0000X | Cardiovascular Disease Physician Cardiovascular Disease | 036082059 | IL | primary |
| 207R00000X | Internal Medicine Physician | 036082059 | IL | |
| 207RI0011X | Interventional Cardiology Physician Interventional Cardiology | 036082059 | IL |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1043228158 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | Aug 4, 2006 |
| Last updated | Oct 27, 2021 |
| Status | Active |
| Sole proprietor | Yes |
| Credential | D.O. |
| Practice address |
1710 W. COURT ST. Kankakee, IL 60901 (815) 936-3200 Fax (815) 936-3203 |
| Mailing address |
1710 W COURT ST Kankakee, IL 60901 |
| Other identifiers |
036082059
· Medicaid (IL) |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 0 | 4 | 3 | 2 | 2 | 8 | 1 | 5 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 0 | 8 | 3 | 4 | 2 | 7 | 1 | 1 |
Sum = 52 · next multiple of 10 = 60 · check digit = 8 · actual last digit = 8
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.