Individual provider Active NPI

Oscar Pelayo Bravo, M.D.

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1205144862
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
125058043 Issued in IL
Practice address
1901 W Harrison St
Chicago, IL 60612-3714
Phone
(312) 864-6000
NPI assigned
Sep 16, 2010
Last updated
Jun 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125058043 IL Primary

Addresses

Primary practice location

1901 W Harrison St
Chicago, IL 60612-3714

Mailing address

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 864-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140918002080 CA Practitioner - Emergency Medicine 3476772773 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125058043ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Aug 1, 2014 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Aug 1, 2014 Accepting new patients

Locations

1650 Creekside Dr
Folsom, CA 95630
Phone (916) 983-7400

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1205144862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123714",
            "telephone_number": "312-864-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123714",
            "telephone_number": "312-864-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAVO",
        "first_name": "OSCAR",
        "middle_name": "PELAYO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-16",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125058043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.