Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mario Gerard Massullo, DO

Individual provider Interventional Cardiology Physician · NPI 1043228158

Mario Gerard Massullo, DO is a Cardiac Surgery in Kankakee, Illinois. Graduated from Ohio University, College of Osteopathic Medicine in 1988, 38 years ago. Practices with Prime Healthcare Illinois Medical Group LLC, a 281-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
38
Trained at
Ohio University, College of Osteopathic Medicine
Licensed in
IL
In the registry since
2006
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1710 W Court St
Kankakee, IL 60901
Phone: (815) 936-3200
Fax: (815) 936-3203
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 100 Provena Way Ste C, Bourbonnais, IL 60914-4798 — (815) 936-3200

Specialties & licences

Cardiovascular Disease Physician (primary) Taxonomy 207RC0000X · Licence 036082059 (IL)
Interventional Cardiology Physician Taxonomy 207RI0011X · Licence 036082059 (IL)
Internal Medicine Physician Taxonomy 207R00000X · Licence 036082059 (IL)

Record details

NPI number1043228158
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedAugust 4, 2006
Last updated in NPPESJuly 20, 2026
Certification dateJuly 20, 2026
Mailing address1710 W Court St, Kankakee, IL 60901-3160

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCARDIAC SURGERY
Also practisesCARDIOVASCULAR DISEASE (CARDIOLOGY), INTERNAL MEDICINE, OSTEOPATHIC MANIPULATIVE MEDICINE, PERIPHERAL VASCULAR DISEASE
Medical schoolOHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 1988 (38 years in practice)
Group practice Prime Healthcare Illinois Medical Group Llc — 281 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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