Individual provider Active NPI

Antonio Perez III, M.D.

  • Anesthesiology Physician
  • Roanoke, VA
National Provider Identifier
1306824875
Registry record updated Mar 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101042141 Issued in VA
Practice address
5115 Bernard Dr
Suite 201
Roanoke, VA 24018-4357
Phone
(540) 345-0289
Fax
(540) 345-9569
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0101042141 VA Primary

Addresses

Primary practice location

5115 Bernard Dr
Suite 201
Roanoke, VA 24018-4357

Mailing address

5115 Bernard Dr
Suite 201
Roanoke, VA 24018-4357
Phone (540) 345-0289

Other identifiers 1

IdentifierTypeStateIssuer
1306824875MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20040510000529 VA Practitioner - Anesthesiology 2264421882

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101042141VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acv Inc Anesthesiology CurrentSince Jan 1, 2010 Accepting new patients
Anesthesiology Consultants of Virginia, Inc Anesthesiology PastSince Jan 1, 2010 Accepting new patients

Locations

5115 Bernard Dr
Ste 201
Roanoke, VA 24018
Phone (540) 345-0289

1102 S Jefferson St
Roanoke, VA 24016
Phone (540) 342-0707

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268179200000",
    "number": "1306824875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184357",
            "telephone_number": "540-345-0289",
            "fax_number": "540-345-9569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184357",
            "telephone_number": "540-345-0289",
            "fax_number": "540-345-9569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "ANTONIO",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2010-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101042141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306824875",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.