Active NPI
Robert C Watkins Jr., MD
- Family Medicine Physician
- Harvey, IL
National Provider Identifier
1790780344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036045969
- Practice address
- 31 W 155TH St
Harvey, IL 60426-3556 - Phone
- (708) 596-5177
- Fax
- (708) 596-5518
- NPI assigned
- Jun 20, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036045969 | IL | Primary |
Addresses
Primary practice location
31 W 155TH St
Harvey, IL 60426-3556
Mailing address
31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 596-5177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K05218 | Other | RAILRAOD MEDICARE | |
| 036045969 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642118400000",
"number": "1790780344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 W 155TH ST",
"city": "HARVEY",
"state": "IL",
"postal_code": "604263556",
"telephone_number": "708-596-5177",
"fax_number": "708-596-5518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 W 155TH ST",
"city": "HARVEY",
"state": "IL",
"postal_code": "604263556",
"telephone_number": "708-596-5177",
"fax_number": "708-596-5518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATKINS",
"first_name": "ROBERT",
"middle_name": "C",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-20",
"last_updated": "2022-01-14",
"certification_date": "2022-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036045969",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILRAOD MEDICARE",
"identifier": "K05218",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036045969",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harvey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.