NPIMap

Organization Active NPI

Rivera Medical Office, LLC

  • Rural Health Clinic/Center
  • Carlyle, IL
National Provider Identifier
1114073756
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
036-096480 Issued in IL
Legal business name
RIVERA MEDICAL OFFICE, LLC
Practice address
1110 Mulliken St
Carlyle, IL 62231-1233
Phone
(618) 594-3613
Fax
(681) 594-4799
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Authorized official

Name
Lisa R Rivera
Title
Office Manager
Phone
(618) 594-3613

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036096480 IL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 036096480 IL
Rural Health Clinic/Center 261QR1300X 036-096480 IL Primary

Addresses

Primary practice location

1110 Mulliken St
Carlyle, IL 62231-1233

Mailing address

1110 Mulliken St
PO Box 147
Carlyle, IL 62231-1233
Phone (618) 594-3613

Other names 1

  • Renato B. Rivera, MD, LLC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1114073756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 MULLIKEN ST",
            "address_2": "PO BOX 147",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622311233",
            "telephone_number": "618-594-3613",
            "fax_number": "681-594-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 MULLIKEN ST",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622311233",
            "telephone_number": "618-594-3613",
            "fax_number": "681-594-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERA MEDICAL OFFICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-594-3613"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036096480",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036096480",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036-096480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renato B. Rivera, MD, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Carlyle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.

Verify at the official NPI Registry.