Active NPI
Ricardo Vallejo, MD
- Pain Medicine (Anesthesiology) Physician
- Bloomington, IL
National Provider Identifier
1669469706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine (Anesthesiology) Physician
- License
- 036107002
- Practice address
- 1015 S Mercer Ave
Bloomington, IL 61701-7107 - Phone
- (309) 662-4321
- Fax
- (309) 661-4532
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | 036107002 | IL | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 036107002 | IL | Primary |
Addresses
Primary practice location
1015 S Mercer Ave
Bloomington, IL 61701-7107
Mailing address
1015 S Mercer Ave
Bloomington, IL 61701-7107
Phone (309) 662-4321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036107002 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesiology Consultants LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Normal, IL
- NPI 1346282522
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584576000000",
"number": "1669469706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 S MERCER AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617017107",
"telephone_number": "309-662-4321",
"fax_number": "309-661-4532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 S MERCER AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617017107",
"telephone_number": "309-662-4321",
"fax_number": "309-661-4532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLEJO",
"first_name": "RICARDO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-04",
"last_updated": "2020-03-19",
"certification_date": "2020-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "IL",
"license": "036107002",
"primary": false
},
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "IL",
"license": "036107002",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036107002",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.