NPIMap

Individual provider Active NPI

Raul Iluminado Perez, M.D

  • Family Medicine Physician
  • Elizabeth, NJ
National Provider Identifier
1003081076
Registry record updated Feb 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA08784100 Issued in NJ
Practice address
605 S Broad St Unit B
Elizabeth, NJ 07202-2601
Phone
(908) 659-0075
Fax
(908) 469-4300
NPI assigned
Apr 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16896 PR
Family Medicine Physician 207Q00000X 25MA08784100 NJ Primary

Addresses

Primary practice location

605 S Broad St Unit B
Elizabeth, NJ 07202-2601

Mailing address

605 S Broad St Unit B
Elizabeth, NJ 07202-2601
Phone (908) 659-0075

Other identifiers 1

IdentifierTypeStateIssuer
0253651MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110128000158 NJ Practitioner - Internal Medicine 7719166396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
P and C Medical Group, LLCGroup PAC ID 0143403469, 4 clinicians

Practice addresses (Care Compare)

530 Westfield Ave
Elizabeth, NJ 07208-1623
Phone (908) 659-0075

Hospital & facility affiliations

  • Robert Wood Johnson Visiting Nurses, Inc Home health agency, North Brunswick, NJ, CCN 317079
  • Trinitas Regional Medical Center Hospital, Elizabeth, NJ, CCN 310027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA08784100NJMDFamily Medicine Physician
16896PRMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Verity Physicians, LLC Past Accepting new patients
Gauri Pharmacy Inc PastSince Jan 10, 2011 Accepting new patients
St Josephs University Medical Center Inc. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DAGDCD/Endpoint/DAGDCD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298073600000",
    "number": "1003081076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S BROAD ST UNIT B",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072022601",
            "telephone_number": "908-659-0075",
            "fax_number": "908-469-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S BROAD ST UNIT B",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072022601",
            "telephone_number": "908-659-0075",
            "fax_number": "908-469-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "RAUL",
        "middle_name": "ILUMINADO",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2011-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "16896",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA08784100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0253651",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

Verify at the official NPI Registry.