Active NPI
Edward Alexander Perez-Conde, M.D.
- Military Health Care Provider
- Iron Mountain, MI
National Provider Identifier
1124095591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- 4301071310
- Practice address
- 325 E H St
Iron Mountain, MI 49801-4760 - Phone
- (906) 774-3300
- NPI assigned
- Mar 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 4301071310 | MI | Primary |
| Emergency Medicine Physician | 207P00000X | 4301071310 | MI |
Addresses
Primary practice location
325 E H St
Iron Mountain, MI 49801-4760
Mailing address
PO Box 549
Iron Mountain, MI 49801-0549
Phone (906) 774-1313
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930124796 | Other | MI | RR MEDICARE |
| 0102200921 | Other | MI | BCBS MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21098 | OK | MD | Pharmacist |
| 4301071310 | MI | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illiana Emergency Physicians LLP | Emergency Medicine | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Greenville, IL
- NPI 1730426941
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341878400000",
"number": "1124095591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 549",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498010549",
"telephone_number": "906-774-1313",
"fax_number": "906-776-5639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014760",
"telephone_number": "906-774-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ-CONDE",
"first_name": "EDWARD",
"middle_name": "ALEXANDER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-03",
"last_updated": "2012-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "MI",
"license": "4301071310",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301071310",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "930124796",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MI",
"identifier": "0102200921",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.