NPIMap

Individual provider Active NPI

Gregorio Cesar Climaco VII, MD

  • Family Medicine Physician
  • O Fallon, IL
National Provider Identifier
1477139202
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036168362 Issued in IL
Practice address
1512 N Green Mount Rd Ste 108
O Fallon, IL 62269-2083
Phone
(618) 624-5510
Fax
(618) 624-5529
NPI assigned
Mar 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036168362 IL Primary

Addresses

Primary practice location

1512 N Green Mount Rd Ste 108
O Fallon, IL 62269-2083

Mailing address

1512 N Green Mount Rd Ste 108
O Fallon, IL 62269-2083
Phone (618) 624-5510

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gclimaco279638@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20240625003326 IL Practitioner - Family Practice 7719420207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

1512 N Green Mount Rd
Suite 108
Ofallon, IL 62269-1953
Phone (618) 624-5510

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc Current Accepting new patients
HSHS Medical Group Inc CurrentSince Aug 1, 2024 Accepting new patients
SJL Health Systems Inc CurrentSince Aug 1, 2024 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

1512 N Green Mount Rd
Ste 108
O Fallon, IL 62269
Phone (618) 624-5510

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

Interoperability endpoints

  • Direct secure messaging: gclimaco279638@ewd.direct.hshs.org

Organizations & group practices 4

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 7

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": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1477139202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD STE 108",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692083",
            "telephone_number": "618-624-5510",
            "fax_number": "618-624-5529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD STE 108",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692083",
            "telephone_number": "618-624-5510",
            "fax_number": "618-624-5529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLIMACO",
        "first_name": "GREGORIO",
        "middle_name": "CESAR",
        "name_prefix": "Mr.",
        "name_suffix": "VII",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-22",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036168362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gclimaco279638@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1512 N Green Mount Rd Ste 108",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

Verify at the official NPI Registry.