Individual provider Active NPI

Juan Manual Villarreal, MD

  • Anesthesiology Physician
  • Bowling Green, KY
National Provider Identifier
1831183375
Registry record updated Sep 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
29019 Issued in KY
Practice address
250 Park St
Bowling Green, KY 42101-1760
Phone
(270) 745-1000
Fax
(270) 393-1913
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 29019 KY Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 29019 KY
Interventional Pain Medicine Physician 208VP0014X 29019 KY
Pain Medicine Physician 208VP0000X 29019 KY

Addresses

Primary practice location

250 Park St
Bowling Green, KY 42101-1760

Mailing address

350 Park St
Ste 203 B
Bowling Green, KY 42101-1784
Phone (270) 393-1912

Other identifiers 2

IdentifierTypeStateIssuer
64290190MedicaidKY
050061640OtherKYRAILROAD MEDICARE

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

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional Pain Specialists of Bowling Green, PLC Pain Medicine PastSince Apr 30, 2003 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251763200000",
    "number": "1831183375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PARK ST",
            "address_2": "STE 203 B",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011784",
            "telephone_number": "270-393-1912",
            "fax_number": "270-393-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011760",
            "telephone_number": "270-745-1000",
            "fax_number": "270-393-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLARREAL",
        "first_name": "JUAN",
        "middle_name": "MANUAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2009-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "29019",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "KY",
            "license": "29019",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "KY",
            "license": "29019",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": "29019",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64290190",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "050061640",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.