NPIMap

Lourdes Delgado-Serrano, MD

Individual provider Active NPI Child & Adolescent Psychiatry Physician · Peoria, IL

NPI 1508834839 · NPPES record last updated Feb 3, 2014

Key facts

NPI
1508834839
Entity type
Individual (NPI type 1)
Primary specialty
Child & Adolescent Psychiatry Physician 2084P0804X
License
036083077 (IL)
Practice address
Dept of Pediatrics
320 E Armstrong
Peoria, IL 61603
Phone
(309) 624-9587
NPI assigned
Mar 11, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 36

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.

View all 36

Medicare Care Compare profile

Specialty
Psychiatry
Education
University of Puerto Rico School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of Illinois (1,134 clinicians)

Practice addresses (Care Compare)

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-3173

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100 (group)
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20080108000902 IL Practitioner - Psychiatry 2365522935 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of the University of Illinois Current
since Nov 1, 2007		 Accepting new patients
Bridgeway Inc Current
since Oct 16, 2002		 Accepting new patients
Bridgeway Inc Child & Adolescent Psychiatry Current
since Oct 16, 2002		 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois Current
since Nov 1, 2007		 Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
Bridgeway Inc. Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

2323 Windish Dr
Galesburg, IL 61401
Phone (309) 344-2323

137 E College St
Kewanee, IL 61443
Phone (309) 852-4331

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

320 E Armstrong Ave
Peoria, IL 61603
Phone (309) 624-9587

507 E Armstrong Ave
Peoria, IL 61603
Phone (309) 681-6960

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 036083077 IL Yes

Addresses

Primary practice location

Dept of Pediatrics
320 E Armstrong
Peoria, IL 61603

Mailing address

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8503

Other identifiers

IdentifierTypeStateIssuer
07215036OtherILBCBS
036083077MedicaidIL
IL01CXOtherILJOHN DEERE

Other names

  • Lourdes Serrano Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2014.

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1508834839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPT OF PEDIATRICS",
            "address_2": "320 E ARMSTRONG",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-624-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELGADO-SERRANO",
        "first_name": "LOURDES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-11",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036083077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083077",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01CX",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LOURDES",
            "last_name": "SERRANO",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peoria, IL

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Sources for this page

Verify at the official NPI Registry.