NPIMap

Individual provider Active NPI

Eladio Pereira, MD

  • Internal Medicine Physician
  • Nogales, AZ
National Provider Identifier
1356318810
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16163 Issued in AZ
Practice address
1852 N Mastick Way
Mariposa Community Health Center
Nogales, AZ 85621-1063
Phone
(520) 281-1550
Fax
(520) 281-1112
NPI assigned
Mar 3, 2006
Last updated
May 26, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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 16163 AZ Primary
Internal Medicine Physician 207R00000X 026617 GA

Addresses

Primary practice location

1852 N Mastick Way
Mariposa Community Health Center
Nogales, AZ 85621-1063

Mailing address

825 N Grand Ave Ste 100
Nogales, AZ 85621-1061
Phone (520) 761-2128

Other identifiers 1

IdentifierTypeStateIssuer
254350MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20051010000898 AZ Practitioner - Internal Medicine 3476578360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Emory University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Taylor St
Patagonia, AZ 85624-9600
Phone (520) 281-1550

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16163AZMDInternal Medicine Physician
026617GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mariposa Community Health Center, Inc Internal Medicine Current Accepting new patients
Mariposa Community Health Center, Inc Internal Medicine CurrentSince Oct 1, 1991 Accepting new patients
Mariposa Community Health Center, Inc Internal Medicine Current Accepting new patients
Mariposa Community Health Center, Inc CurrentSince Oct 1, 1991 Accepting new patients
Mariposa Community Health Center, Inc Internal Medicine Past Accepting new patients

Locations

1852 N Mastick Way
Nogales, AZ 85621
Phone (520) 375-5032

507 N Western Ave
Nogales, AZ 85621
Phone (520) 229-0085

825 N Grand Ave
Ste 100
Nogales, AZ 85621
Phone (520) 761-2128

Interoperability endpoints

  • Direct secure messaging: eladio.pereira.p1@direct.azch.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Maternal Child Health Center of ExcellenceNogales, AZ, CCN 031079 Federally qualified health center W-2 Managing Employee Jan 1, 1998

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, 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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1356318810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GRAND AVE STE 100",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211061",
            "telephone_number": "520-761-2128",
            "fax_number": "520-281-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1852 N MASTICK WAY",
            "address_2": "MARIPOSA COMMUNITY HEALTH CENTER",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211063",
            "telephone_number": "520-281-1550",
            "fax_number": "520-281-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREIRA",
        "first_name": "ELADIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "16163",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "026617",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254350",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nogales, AZ

Sources for this page

Verify at the official NPI Registry.