Lizzette Colon-Ramos, M.D.
Individual provider Active NPI Geriatric Medicine (Internal Medicine) Physician · Effingham, IL
NPI 1114922101 · NPPES record last updated Jan 24, 2014
Key facts
- NPI
- 1114922101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- License
- 8062 (PR)
- Practice address
- 1901 S 4TH St, Ste 21
VA Effingham Cboc
Effingham, IL 62401-4489 - Phone
- (217) 347-7600
- Fax
- (217) 342-9733
- NPI assigned
- Jun 16, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180404002811 | PR | Order and Referring Only - Internal Medicine |
3779546346 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008062 | PR | MD | Clinical Psychologist |
| 13611 | TN | MD | Clinical Social Worker |
| 8062 | PR | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MD Management Corp | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 8062 | PR | Yes |
Addresses
Primary practice location
1901 S 4TH St, Ste 21
VA Effingham Cboc
Effingham, IL 62401-4489
Mailing address
10917 E Aminoff Dr
Effingham, IL 62401-4489
Phone (217) 881-9059
Other names
- Dr. Lizzette Colon
Other providers in Effingham, IL
- Connie L Coatney
- Michael Arthur Cochran
- Allison Anne Cogar
- Diana L Cole
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- Community Support Systems
- Community Support Systems CFC 20
All providers in Effingham, IL · Geriatric Medicine (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 Jan 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.