Active NPI
Antonio B Cruz, MD
- General Practice Physician
- Hanover Park, IL
National Provider Identifier
1013013374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 636040977
- Practice address
- 1601 Tanglewood
Suite 106
Hanover Park, IL 60133 - Phone
- (630) 289-7800
- Fax
- (630) 289-9187
- NPI assigned
- Sep 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 636040977 | IL | Primary |
Addresses
Primary practice location
1601 Tanglewood
Suite 106
Hanover Park, IL 60133
Mailing address
1601 Tanglewood
Suite 106
Hanover Park, IL 60133
Phone (630) 289-7800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 362715536 | Other | IL | BCBS |
| 036040977 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 636040977 | IL | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heyer Celestial Paul Devarapalli MD SC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Arlington Heights, IL
- NPI 1235327677
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224201600000",
"number": "1013013374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 TANGLEWOOD",
"address_2": "SUITE 106",
"city": "HANOVER PARK",
"state": "IL",
"postal_code": "60133",
"telephone_number": "630-289-7800",
"fax_number": "630-289-9187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 TANGLEWOOD",
"address_2": "SUITE 106",
"city": "HANOVER PARK",
"state": "IL",
"postal_code": "60133",
"telephone_number": "630-289-7800",
"fax_number": "630-289-9187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "ANTONIO",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2008-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "636040977",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "362715536",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036040977",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hanover Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.