NPIMap

Individual provider Active NPI

Beatriz C Pardo, MD

  • Internal Medicine Physician
  • Belleville, IL
National Provider Identifier
1780670844
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036092347 Issued in IL
Practice address
1418 Cross St Ste 250
Belleville, IL 62269-2988
Phone
(618) 236-8000
Fax
(618) 236-8005
NPI assigned
Sep 23, 2005
Last updated
Feb 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036092347 IL Primary

Addresses

Primary practice location

1418 Cross St Ste 250
Belleville, IL 62269-2988

Mailing address

1418 Cross St Ste 250
Shiloh, IL 62269-2988
Phone (618) 236-8000

Other identifiers 2

IdentifierTypeStateIssuer
1780670844MedicaidIL
036092347MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20050926000222 IL Practitioner - Internal Medicine 3779517081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

1404 Cross St
Shiloh, IL 62269-2988
Phone (618) 607-3055

1418 Cross St
Suite 350
Shiloh, IL 62269-2988
Phone (618) 607-3900

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 257-6220

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Dec 24, 2017 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Dec 24, 2017 Accepting new patients
Healthcare Physicians of Southern Illinois, PC Internal Medicine Past Accepting new patients
PC Associates, LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

1418 Cross St
Ste 250
Shiloh, IL 62269
Phone (618) 236-8000

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6481

Interoperability endpoints

  • Direct secure messaging: bpardo170936@direct.carenet.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial HospitalBelleville, IL, CCN 140185 Hospital Corporate Director Jan 1, 2017
Memorial Care CenterBelleville, IL, CCN 145102 Skilled nursing facility Corporate Director Jan 1, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1780670844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 CROSS ST STE 250",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622692988",
            "telephone_number": "618-236-8000",
            "fax_number": "618-236-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 CROSS ST STE 250",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622692988",
            "telephone_number": "618-236-8000",
            "fax_number": "618-236-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARDO",
        "first_name": "BEATRIZ",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036092347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780670844",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092347",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1418 Cross St Ste 250",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.