Ivan R Lopez MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036109448 Issued in IL

Legal business name

IVAN R LOPEZ MD PC

Practice address

2003 Montgomery Rd
Suite 106 107
Aurora, IL 60504-9078

Phone

(630) 340-4211

NPI assigned

Feb 6, 2010

Organization subpart

Yes

Parent organization

IVAN R LOPEZ MD PCAs reported in NPPES

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

Authorized official

Name

Ivan Roger Lopez, MDNPI 1992845069

Title

Owner

Phone

(708) 890-9115

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ProHealth Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Ivan R Lopez MD PC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ivan R Lopez, M.D.

  • Family Medicine Physician
  • Aurora, IL
  • NPI 1992845069
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1265414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1740512359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6313",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605980313",
            "telephone_number": "708-890-9115",
            "fax_number": "630-340-3283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 MONTGOMERY RD",
            "address_2": "SUITE 106 107",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605049078",
            "telephone_number": "630-340-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVAN R LOPEZ MD PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVAN R LOPEZ MD PC",
        "enumeration_date": "2010-02-06",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-890-9115",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036109448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036109448",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "36109448",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProHealth Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProHealth Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kanako Ishida, DNP, FNP-BC
• Joanna Isitt
• Heather Islami
• Haya Mohammed Ismail, NP
• Edwin R Italia
• Luke D Ivers, DPT
• Ivone Arelllano Beron, DDS, Ms, LTD
• Iyad a. Kashow MD.LTD
• Iyad a.Kashow MD LTD
• Janani P Iyer

• Family Medicine Physician in Aurora, IL
• Providers in Aurora, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.