Individual provider Active NPI

Patricia Panelli, MD

  • Emergency Medicine Physician
  • Morris, IL
National Provider Identifier
1528068970
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036090961 Issued in IL
Practice address
100 Gore Rd
Morris, IL 60450-9466
Phone
(815) 364-8919
NPI assigned
Jul 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036090961 IL Primary

Addresses

Primary practice location

100 Gore Rd
Morris, IL 60450-9466

Mailing address

725 School St Ste a
Morris, IL 60450-1207
Phone (815) 942-2932

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161003000264 IN Practitioner - Emergency Medicine 4789646522 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince Sep 27, 2016 Accepting new patients
Prairie Emergency Services, SC Emergency Medicine Past Accepting new patients
Suburban Emergency Physicians Group, SC Emergency Medicine Past Accepting new patients

Locations

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

10240 Calumet Ave
Munster, IN 46321
Phone (219) 440-5286

901 MacArthur Blvd
Munster, IN 46321
Phone (219) 703-1443

9660 Wicker Ave
Saint John, IN 46373
Phone (219) 226-2203

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1528068970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-942-2932",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GORE RD",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604509466",
            "telephone_number": "815-364-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANELLI",
        "first_name": "PATRICIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036090961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

Verify at the official NPI Registry.