Robert Walter Lopez

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036167076 Issued in IL

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(309) 655-2109

NPI assigned

Apr 18, 2021

Last updated

Oct 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Henry County Health Center Inc

  • General Practice Physician
  • Mt Pleasant, IA
  • NPI 1871177477
  Medicare reassignment NPD
• Henry County Health Center, Inc.

  • Critical Access Hospital
  • Mt Pleasant, IA
  • NPI 1811571417
  Medicare reassignment NPD
• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884
  Medicare reassignment NPD

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

{
    "created_epoch": "1618704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1669053948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "ROBERT",
        "middle_name": "WALTER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-18",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036167076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Long
• Nancy Long
• Longevity Health and Wellness
• Anne Look, APN
• Kimberly K Lopez
• Shannon R Lopiccolo, PT
• Lori Bushell Counseling LLC
• Tamara Marie Lott, LCPC, CRC
• Lotus Center for Women's Mental Health and Psychiatry
• Carol Sue Loughridge, PTA

• Emergency Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.