Active NPI
Stephen P Rivera, M.D.
- Psychiatry Physician
- Hawthorn Woods, IL
National Provider Identifier
1396863924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036089771
- Practice address
- 5 Middletree Lane
Hawthorn Woods, IL 60047 - Phone
- (224) 286-7318
- Fax
- (847) 381-0301
- NPI assigned
- Mar 26, 2007
- Last updated
- Sep 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036089771 | IL | Primary |
Addresses
Primary practice location
5 Middletree Lane
Hawthorn Woods, IL 60047
Mailing address
5 Middletree LN
Hawthorn Woods, IL 60047-8993
Phone (224) 286-7318
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001620065 | Other | IL | BCBS |
| 036089771 | Medicaid | IL | |
| 260050348 | Other | IL | PALMETTO GBA |
Other names 1
- Stephen Rivera, LTD
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Organizations & group practices 1
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.
-
- Psychiatry Physician
- Hawthorn Woods, IL
- NPI 1821209610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410739200000",
"number": "1396863924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 MIDDLETREE LN",
"city": "HAWTHORN WOODS",
"state": "IL",
"postal_code": "600478993",
"telephone_number": "224-286-7318",
"fax_number": "847-381-0301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 MIDDLETREE LANE",
"city": "HAWTHORN WOODS",
"state": "IL",
"postal_code": "60047",
"telephone_number": "224-286-7318",
"fax_number": "847-381-0301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "STEPHEN",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2014-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036089771",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "001620065",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036089771",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "260050348",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHEN",
"last_name": "RIVERA, LTD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Hawthorn Woods, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.