NPIMap

Individual provider Active NPI

Julio Diosman Pernia-Cuberos, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1679067672
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036156493 Issued in IL
Practice address
3059 W 26TH St
Chicago, IL 60623-4131
Phone
(773) 584-6200
Fax
(844) 285-1003
NPI assigned
Jun 22, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NJ
Internal Medicine Physician 207R00000X 036156493 IL Primary

Addresses

Primary practice location

3059 W 26TH St
Chicago, IL 60623-4131

Mailing address

2001 S California Ave Ste 100
Chicago, IL 60608-2486
Phone (773) 584-6200

Other identifiers 1

IdentifierTypeStateIssuer
036156493MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210809000121 IL Practitioner - Internal Medicine 2264836691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esperanza Health CentersGroup PAC ID 2961453105, 53 clinicians

Practice addresses (Care Compare)

3059 W 26TH St
Chicago, IL 60623-4131
Phone (773) 584-6200

Hospital & facility affiliations

  • Saint Anthony Hospital Hospital, Chicago, IL, CCN 140095

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Centers CurrentSince Jul 19, 2021 Accepting new patients
Esperanza Health Centers CurrentSince Jul 19, 2021 Accepting new patients
Esperanza Health Centers Current Accepting new patients
Esperanza Health Centers Past Accepting new patients
Esperanza Health Centers Past Accepting new patients

Locations

2724 W Cermak Rd
Chicago, IL 60608

2001 S California Ave
Chicago, IL 60608
Phone (773) 484-1201

3059 W 26th St
Chicago, IL 60623
Phone (312) 243-3769

2001 S California Ave
Ste 100
Chicago, IL 60608
Phone (773) 640-5785

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11903/brand/1/csg/1/fhir/r4
  • Direct secure messaging: julio.pernia-cuberos.1@11903.direct.athenahealth.com

Organizations & group practices 5

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 8

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": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1679067672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S CALIFORNIA AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082486",
            "telephone_number": "773-584-6200",
            "fax_number": "844-285-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3059 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234131",
            "telephone_number": "773-584-6200",
            "fax_number": "844-285-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERNIA-CUBEROS",
        "first_name": "JULIO",
        "middle_name": "DIOSMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-22",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036156493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036156493",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.