Active NPI
Vivian A Illera, MD
- Rheumatology Physician
- Wichita, KS
National Provider Identifier
1790741148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 04-25436
- Practice address
- 1921 N Webb Rd
Wichita, KS 67206-3405 - Phone
- (316) 612-4815
- Fax
- (316) 681-0244
- NPI assigned
- Apr 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 04-25436 | KS | Primary |
Addresses
Primary practice location
1921 N Webb Rd
Wichita, KS 67206-3405
Mailing address
1921 N Webb Rd
Wichita, KS 67206-3405
Phone (316) 612-4815
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100170460B | Medicaid | KS |
Other names 1
- Vivian Ana Illera
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-25436 | KS | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310342400000",
"number": "1790741148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1921 N WEBB RD",
"city": "WICHITA",
"state": "KS",
"postal_code": "672063405",
"telephone_number": "316-612-4815",
"fax_number": "316-681-0244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1921 N WEBB RD",
"city": "WICHITA",
"state": "KS",
"postal_code": "672063405",
"telephone_number": "316-612-4815",
"fax_number": "316-681-0244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLERA",
"first_name": "VIVIAN",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-25",
"last_updated": "2011-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "KS",
"license": "04-25436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100170460B",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "VIVIAN",
"last_name": "ILLERA",
"middle_name": "ANA",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.