Individual provider Active NPI

Julio R Loret de Mola, MD

  • Reproductive Endocrinology Physician
  • Springfield, IL
National Provider Identifier
1326071887
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
036-118863 Issued in IL
Practice address
751 N Rutledge St
Suite 0100
Springfield, IL 62702-4968
Phone
(217) 545-8000
Fax
(217) 545-3119
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036-118863 IL
Reproductive Endocrinology Physician 207VE0102X 036-118863 IL Primary

Addresses

Primary practice location

751 N Rutledge St
Suite 0100
Springfield, IL 62702-4968

Mailing address

751 N Rutledge St
Ste 3100
Springfield, IL 62702-4968
Phone (217) 545-8000

Other identifiers 1

IdentifierTypeStateIssuer
036118863MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address julioloretdemola@siusm.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070913000556 IL Practitioner - Obstetrics/Gynecology 3577500453 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-118863ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 1, 2007 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 1, 2007 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Siu Physicians & Surgeons, Inc Past Accepting new patients

Locations

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

415 N 9th St
#6W70
Springfield, IL 62702

751 N Rutledge St
Ste 100
Springfield, IL 62702

751 N Rutledge St
Ste 3100
Springfield, IL 62702
Phone (217) 545-8417

Interoperability endpoints

  • Direct secure messaging: julioloretdemola@siusm.allscriptsdirect.net

Organizations & group practices 5

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1326071887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST",
            "address_2": "STE 3100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST",
            "address_2": "SUITE 0100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORET DE MOLA",
        "first_name": "JULIO",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-118863",
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "IL",
            "license": "036-118863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036118863",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "julioloretdemola@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "751 N Rutledge St",
            "address_2": "SUITE 0100",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627024968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.