Active NPI
Peter Joseph Lopez, PAC
- Physician Assistant
- Chicago, IL
National Provider Identifier
1083789952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1431 N Claremont Ave
Chicago, IL 60622-1702 - Phone
- (773) 278-2000
- NPI assigned
- Nov 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | IL | Primary |
Addresses
Primary practice location
1431 N Claremont Ave
Chicago, IL 60622-1702
Mailing address
1440 Westchester Blvd
Westchester, IL 60154-3631
Phone (708) 865-8106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110103000945 | IL | Practitioner - Physician Assistant | 7416145677 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-000728 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083789952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 WESTCHESTER BLVD",
"city": "WESTCHESTER",
"state": "IL",
"postal_code": "601543631",
"telephone_number": "708-865-8106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1431 N CLAREMONT AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221702",
"telephone_number": "773-278-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "PETER",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.