Paulo Roberto Kossatz Michelini

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

90200000X Issued in IL

Practice address

221 NE Glen Oak Ave
Peoria, IL 61636-0001

Phone

(309) 672-4974

NPI assigned

Jun 18, 2018

Last updated

Jun 18, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prairie Du Chien Memorial Hospital Association IncGroup PAC ID 4981698537, 49 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Crossing Rivers Health Medical Center Hospital, Prairie Du Chien, WI, CCN 521330

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pmichelini936935@direct.emplifyhealth.org

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.

• Prairie Du Chien Memorial Hospital Association Inc

  dba Crossing Rivers Health

  • Critical Access Hospital
  • Prairie Du Chien, WI
  • NPI 1619024197
  Medicare reassignment Care Compare group NPD
• Medicos General PLLC

  dba Medicos Para La Familia

  • Family Medicine Physician
  • Memphis, TN
  • NPI 1952402885
  Medicare reassignment NPD
• The Camellia Foundation

  dba Clinica Camellia

  • Family Medicine Physician
  • Memphis, TN
  • NPI 1609169713
  Medicare reassignment NPD

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

• Prairie Du Chien Memorial Hospital Association Inc

  dba Crossing Rivers Health

  • Critical Access Hospital
  • Prairie Du Chien, WI
  • NPI 1619024197
  Care Compare affiliation

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1164916706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360001",
            "telephone_number": "309-672-4974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Main St Ste C",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616021080",
            "country_code": "US",
            "telephone_number": "309-672-4977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHELINI",
        "first_name": "PAULO ROBERTO",
        "middle_name": "KOSSATZ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "90200000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D. Cashman, M.D., S.C.
• Michael D. Tarantino, M.D. S.C.
• Michael E Longevin MDSC
• Jon Christopher Michel, MD
• Heather Michelini
• Michelle Matzke Therapy, PLLC (Healing Blooms Therapy)
• Matthew Robert Michels
• Mid Illini Surgical Associates SC
• Kristen Middendorf, OTR/L
• Midwest Business Partners LLC (Hear Always)

• Family Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.