NPIMap

Organization Active NPI

Rivera Medical, LLC

  • Rural Health Clinic/Center
  • Carlyle, IL
National Provider Identifier
1467756338
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
036-096480 Issued in IL
Legal business name
RIVERA MEDICAL, LLC
Practice address
1110 Mulliken St
Carlyle, IL 62231-1233
Phone
(618) 594-3613
Fax
(618) 594-4799
NPI assigned
Jan 6, 2011
Last updated
Jun 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Lisa Rivera
Title
Office Manager
Phone
(618) 594-3613

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 036-096480 IL Primary
Internal Medicine Physician 207R00000X 036-096480 IL
Pediatrics Physician 208000000X 036-096480 IL

Addresses

Primary practice location

1110 Mulliken St
Carlyle, IL 62231-1233

Mailing address

1110 Mulliken St
Carlyle, IL 62231-1233
Phone (618) 594-3613

National Provider Directory

National Provider Directory

Locations

1110 Mulliken St
Carlyle, IL 62231
Phone (618) 594-3613

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1467756338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 MULLIKEN ST",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622311233",
            "telephone_number": "618-594-3613",
            "fax_number": "618-594-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 MULLIKEN ST",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622311233",
            "telephone_number": "618-594-3613",
            "fax_number": "618-594-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERA MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-594-3613"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036-096480",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-096480",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-096480",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlyle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.