Individual provider Active NPI

Pablo Ermelo G Perez, MD

  • Family Medicine Physician
  • Elgin, IL
National Provider Identifier
1578658993
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-096278 Issued in IL
Practice address
1425 N Randall Rd
Elgin, IL 60123-2300
Phone
(224) 783-3450
Fax
(224) 783-1124
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 22369 SC
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 40524 WI
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 036-096278 IL
Family Medicine Physician 207Q00000X 036-096278 IL Primary

Addresses

Primary practice location

1425 N Randall Rd
Elgin, IL 60123-2300

Mailing address

1425 N Randall Rd
Elgin, IL 60123-2300
Phone (224) 783-3450

Other practice location 1

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 649-6000

Other identifiers 2

IdentifierTypeStateIssuer
036096278OtherILLICENSE
223699MedicaidSC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pperez312534@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080725000159 IL Practitioner - Family PracticePractitioner - Sports MedicinePractitioner - Preventive Medicine 7113090085 Reassigns benefits to 3 organizations
I20210701002317 WI Practitioner - Family Practice 7113090085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Preventive Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1425 N Randall Rd
Elgin, IL 60123-2300
Phone (847) 742-9800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue178
Removal of skin lesions41
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-096278ILMDUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
40524WIMDUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
22369SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Aug 1, 2021 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Aug 2, 2021 Accepting new patients
Proctor Health Systems CurrentSince Sep 1, 2015 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2008 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 2, 2021 Accepting new patients
Methodist Medical Center of Illinois Family Medicine CurrentSince Jul 1, 2008 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Aug 1, 2021 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Proctor Health Systems Family Medicine Current Accepting new patients
Self Regional Healthcare Past Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

75 Remittance Dr
Dept 6875
Chicago, IL 60675

29373 Network Pl
Chicago, IL 60673

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

900 Main St
Ste 210
Peoria, IL 61602
Phone (224) 522-9945

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A1
Peoria, IL 61602

900 Main St
Ste 500
Peoria, IL 61602
Phone (309) 637-3500

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

Interoperability endpoints

  • Direct secure messaging: pperez312534@direct.myadvocateaurora.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 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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1578658993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601232300",
            "telephone_number": "224-783-3450",
            "fax_number": "224-783-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601232300",
            "telephone_number": "224-783-3450",
            "fax_number": "224-783-1124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 W Oklahoma Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532154330",
            "country_code": "US",
            "telephone_number": "414-649-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "PABLO ERMELO",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "22369",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "WI",
            "license": "40524",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "IL",
            "license": "036-096278",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-096278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036096278",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223699",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pperez312534@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.