Ruben A Medrano, MD – Internal Medicine Physician

Key facts

NPI: 1073509683
Entity type: Individual (NPI type 1)
Primary specialty: Internal Medicine Physician 207R00000X
License: 036095457 (IL)
Practice address: 1000 W Harlem Ave
Monmouth, IL 61462-1007
Phone: (309) 734-1414
Fax: (309) 734-0323
NPI assigned: Sep 20, 2005
Sex: Male
Sole proprietor: No

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.

St Mary Medical Center Family Medicine Physician · Galesburg, IL · NPI 1457308710

NPD (past) INTERNAL MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
St Mary Medical Center	Internal Medicine	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician	207R00000X	036095457	IL	Yes

Addresses

Primary practice location

1000 W Harlem Ave
Monmouth, IL 61462-1007

Mailing address

1000 W Harlem Ave
Monmouth, IL 61462-1007
Phone (309) 734-1414

Other identifiers

Identifier	Type	State	Issuer
371352599001	Medicaid	IL

Other providers in Monmouth, IL

All providers in Monmouth, IL · Internal Medicine Physician in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.