NPIMap

Individual provider Active NPI

Roberto Gordillo Perez, MD

  • Pediatric Nephrology Physician
  • Peoria, IL
National Provider Identifier
1407084759
Registry record updated Apr 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
036.126924 Issued in IL
Practice address
530 NE Glen Oak Ave
Department of Pediatrics
Peoria, IL 61637-0001
Phone
(309) 624-3313
Fax
(309) 655-2565
NPI assigned
Jun 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X 036.126924 IL Primary
Pediatrics Physician 208000000X 036.126924 IL

Addresses

Primary practice location

530 NE Glen Oak Ave
Department of Pediatrics
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Department of Pediatrics
Peoria, IL 61637-0001
Phone (309) 624-3313

Other names 1

  • Roberto Gordillo Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20160705000875 WA Practitioner - NephrologyPractitioner - Pediatric Medicine 5193878627 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Pediatric Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Association of Chrmc and University PhysiciansGroup PAC ID 9133032964, 313 clinicians
Seattle Childrens HospitalGroup PAC ID 9032021050, 113 clinicians

Practice addresses (Care Compare)

1815 13TH St
Everett, WA 98201-1679
Phone (425) 783-6200

4800 Sand Point Way NE
Seattle, WA 98105-3901
Phone (206) 987-2000

900 Pacific Ave
Suite 100
Everett, WA 98201-4188
Phone (425) 304-6080

Hospital & facility affiliations

  • Seattle Children'S Hospital Hospital, Seattle, WA, CCN 503300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.126924ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Pediatrics CurrentSince Jul 26, 2016 Accepting new patients
Seattle Childrens Hospital CurrentSince Nov 1, 2020 Accepting new patients
The Association of Chrmc and University Physicians Pediatrics CurrentSince Jul 1, 2016 Accepting new patients
Seattle Children'S Hospital Current Accepting new patients
Multicare Health System CurrentSince Jul 26, 2016 Accepting new patients
Multicare Health System Current Accepting new patients
Association of CHMC and University Physicians Pediatrics CurrentSince Jul 1, 2016 Accepting new patients
The Association of University Physicians CurrentSince Jul 1, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Seattle Children'S Hospital Past Accepting new patients
Seattle Children'S Hospital Past Accepting new patients

Locations

1035 116th Ave NE
Bellevue, WA 98004
Phone (425) 451-4141

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

8232 W Grandridge Blvd
Kennewick, WA 99336
Phone (509) 582-1700

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

1780 NW Myhre Rd
Ste 2120
Silverdale, WA 98383
Phone (360) 782-3100

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Interoperability endpoints

  • Direct secure messaging: rgordilloperez35914@direct.seattlechildrens.org

Organizations & group practices 11

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.

Hospital & facility affiliations 5

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302566400000",
    "number": "1407084759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-3313",
            "fax_number": "309-655-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-3313",
            "fax_number": "309-655-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDILLO PEREZ",
        "first_name": "ROBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2011-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "IL",
            "license": "036.126924",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.126924",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTO",
            "last_name": "GORDILLO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.