NPIMap

Individual provider Active NPI

Raul V Guerrero, MD

  • Internal Medicine Physician
  • Ottawa, IL
National Provider Identifier
1053307660
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036079759 Issued in IL
Practice address
1614 E Norris Dr
Ottawa, IL 61350-3681
Phone
(815) 433-1010
Fax
(815) 433-0067
NPI assigned
Sep 20, 2005
Last updated
Mar 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036079759 IL Primary

Addresses

Primary practice location

1614 E Norris Dr
Ottawa, IL 61350-3681

Mailing address

1614 E Norris Dr
Ottawa, IL 61350-3681
Phone (815) 433-1010

Other identifiers 1

IdentifierTypeStateIssuer
036079759MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20050512000275 IL Practitioner - Internal Medicine 3274573951 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

124 SW Adams St
Peoria, IL 61602-1308

1614 E Norris Dr
OBGYN and Anti Coag
Ottawa, IL 61350-3681
Phone (815) 431-0435

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036079759ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mendota Community Hospital CurrentSince Apr 1, 2015 Accepting new patients
24 On Physicians, PC CurrentSince Feb 15, 2015 Accepting new patients
Mendota Community Hospital CurrentSince Apr 1, 2015 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
24 On Physicians, P.C. CurrentSince Feb 15, 2015 Accepting new patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Ottawa Regional Hospital & Healthcare Center Past Accepting new patients

Locations

1401 E 12th St
Mendota, IL 61342
Phone (815) 539-7461

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

1050 E Norris Dr
Ste 3A
Ottawa, IL 61350
Phone (815) 431-5746

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 9

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

Hospital & facility affiliations 5

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364342400000",
    "number": "1053307660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERRERO",
        "first_name": "RAUL",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2013-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036079759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036079759",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

Verify at the official NPI Registry.