NPIMap

Individual provider Active NPI

Michelle Vasquez, MD

  • Family Medicine Physician
  • Peru, IL
National Provider Identifier
1164629531
Registry record updated Sep 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036124821 Issued in IL
Practice address
920 West St
Suite 311
Peru, IL 61354-2763
Phone
(815) 223-9214
Fax
(815) 223-9322
NPI assigned
Jun 29, 2007
Last updated
Sep 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036124821 IL Primary
Obstetrics & Gynecology Physician 207V00000X 036124821 IL

Addresses

Primary practice location

920 West St
Suite 311
Peru, IL 61354-2763

Mailing address

1305 6TH St
Peru, IL 61354-2759
Phone (815) 780-5030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100914000609 IL Practitioner - Family Practice 2365567328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mendota Community HospitalGroup PAC ID 2264335777, 51 clinicians

Practice addresses (Care Compare)

1650 Midtown Rd
Peru, IL 61354-1200
Phone (815) 538-1351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036124821ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Jun 20, 2023 Accepting new patients
Mendota Community Hospital CurrentSince Jun 19, 2023 Accepting new patients
Mendota Community Hospital Family Medicine Current Accepting new patients
Mendota Community Hospital CurrentSince Jun 19, 2023 Accepting new patients
Saint James Hospital CurrentSince Jun 20, 2023 Accepting new patients
Mendota Community Hospital Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Osf Multi-Specialty Group Past Accepting new patients

Locations

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1650 Midtown Rd
Peru, IL 61354
Phone (815) 220-1122

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348444800000",
    "number": "1164629531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 6TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613542759",
            "telephone_number": "815-780-5030",
            "fax_number": "815-780-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 WEST ST",
            "address_2": "SUITE 311",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613542763",
            "telephone_number": "815-223-9214",
            "fax_number": "815-223-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "MICHELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2012-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036124821",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036124821",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IL

Sources for this page

Verify at the official NPI Registry.