PABLO E PEREZ MD NPI 1578658993

Family Medicine in Peoria, IL

About PABLO PEREZ

Pablo Perez is a provider in Peoria, IL with more than 27 years of experience. The NPI number assigned to this provider is 1578658993. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an individual and their NPI record was last updated 0 years ago. Pablo Perez is registered with Medicare and accepts claims assignment.

NPI1578658993 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name PABLO E PEREZ MD
Provider Location Address900 MAIN ST STE 210 PEORIA, IL 61602 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address900 MAIN ST STE 210 PEORIA, IL 61602 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOTHER
Graduation Year1991
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-03-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date10-05-2017 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

PABLO E PEREZ MD
900 MAIN ST STE 210
PEORIA, IL
ZIP 61602
Phone: (309) 689-6074
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Mailing Address

PABLO E PEREZ MD
900 MAIN ST STE 210
PEORIA, IL
ZIP 61602
Phone: (309) 689-6074

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.22369
License StateSC
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Medicare Participation

PECOS PAC ID7113090085
PECOS Enrollment IDI20080725000159
Accepts Medicare Assignment? Yes Additional informationCallout Tooltip"What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.

Hospital Affiliations

Hospital Name CMS Certification Number (CCN)
METHODIST MEDICAL CENTER OF ILLINOIS140209
PROCTOR HOSPITAL140013
SAINT FRANCIS MEDICAL CENTER140067
PEKIN MEMORIAL HOSPITAL140120

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine036096278ILNo

Taxonomy Description: a specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide poisoning, gas gangrene, non-healing wounds, tissue damage from radiation and burns, and bone infections. This specialist also serves as a consultant to other physicians in all aspects of hyperbaric chamber operations, and assesses risks and applies appropriate standards to prevent disease and disability in divers and other persons working in altered atmospheric conditions.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
5254MEDICARE PIN (08)SC
G89242MEDICARE UPIN (02)SC
1127MEDICARE PIN (08)SC
036096278OTHER (01)IL
223699MEDICAID (05)SC
1124MEDICARE PIN (08)SC

Map Location


PABLO E PEREZ MD address is 900 MAIN ST STE 210 PEORIA, IL 61602

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1518075282DR. JAY S HARMS MD
Individual
Family Medicine900 MAIN ST STE 210
PEORIA, IL 61602
(309) 689-6074
1720405541 JULIE ANN DRISCOLL APN
Individual
Nurse Practitioner900 MAIN ST STE 210
PEORIA, IL 61602
(309) 672-4565