NPIMap

Individual provider Active NPI

Jaime E Ruiz Montero, MD

  • Internal Medicine Physician
  • East Chicago, IN
National Provider Identifier
1245360726
Registry record updated Jan 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01052348A Issued in IN
Practice address
4320 Fir Street
Suite 410
East Chicago, IN 46312-3052
Phone
(219) 397-8965
Fax
(219) 397-9351
NPI assigned
Mar 6, 2007
Last updated
Jan 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01052348 IN
Internal Medicine Physician 207R00000X 01052348A IN Primary

Addresses

Primary practice location

4320 Fir Street
Suite 410
East Chicago, IN 46312-3052

Mailing address

9660 Wicker Avenue
St John, IN 46373-9487
Phone (219) 397-8965

Other identifiers 4

IdentifierTypeStateIssuer
200287720BMedicaidIN
90001247OtherILBCBSIL
000000224980OtherANTHEM BCBS
000000224980OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050228000981 IN Practitioner - Internal Medicine 6406809607 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
219 Health Network IncGroup PAC ID 0547521452, 70 clinicians

Practice addresses (Care Compare)

100 W Chicago Ave
Suite F
East Chicago, IN 46312-3261
Phone (219) 392-7016

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01052348INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
219 Health Network Inc Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
St Catherine Hospital Inc CurrentSince May 1, 2015 Accepting new patients
219 Health Network, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Community Care Network Inc Internal Medicine CurrentSince Jul 1, 2012 Accepting new patients
St. Catherine Hospital Inc. CurrentSince May 1, 2015 Accepting new patients
219 Health Network Inc Past Accepting new patients

Locations

100 W Chicago Ave
Ste F
East Chicago, IN 46312
Phone (219) 392-7016

2020 E Columbus Dr
#A
East Chicago, IN 46312
Phone (219) 397-8965

4320 Fir St
Unit 410
East Chicago, IN 46312
Phone (219) 392-7665

4321 Fir St
East Chicago, IN 46312
Phone (219) 392-1700

6924 Indianapolis Blvd
Blvd
Hammond, IN 46324
Phone (219) 844-9060

7217 Indianapolis Blvd
Hammond, IN 46324
Phone (219) 554-4080

8141 Kennedy Ave
Highland, IN 46322
Phone (219) 838-5040

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

9660 Wicker Ave
Saint John, IN 46373
Phone (219) 226-2203

Interoperability endpoints

  • Direct secure messaging: jruizmontero7626@ssdirect.comhs.org

Organizations & group practices 7

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 6

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": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1245360726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9660 WICKER AVENUE",
            "city": "ST JOHN",
            "state": "IN",
            "postal_code": "463739487",
            "telephone_number": "219-397-8965",
            "fax_number": "219-397-9351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FIR STREET",
            "address_2": "SUITE 410",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123052",
            "telephone_number": "219-397-8965",
            "fax_number": "219-397-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ MONTERO",
        "first_name": "JAIME",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01052348",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01052348A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200287720B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "90001247",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000224980",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000224980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.