Individual provider Active NPI

Valerie Elizabeth Lawrence, M.D.

  • Pediatrics Physician
  • Mattoon, IL
National Provider Identifier
1912265117
Registry record updated Aug 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036138867 Issued in IL
Practice address
2512 Hurst Dr
Ste 130
Mattoon, IL 61938
Phone
(217) 258-5900
Fax
(217) 258-3686
NPI assigned
Apr 25, 2012
Last updated
Aug 6, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 63210 NY
Pediatrics Physician 208000000X 036138867 IL Primary

Addresses

Primary practice location

2512 Hurst Dr
Ste 130
Mattoon, IL 61938

Mailing address

611 W Park St
BWPC
Urbana, IL 61801
Phone (217) 383-6941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200312001373 HI Practitioner - Pediatric Medicine 2567761166 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63210NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Queens North Hawaii Community Hospital CurrentSince Feb 1, 2020 Accepting new patients
Queens North Hawaii Community Hospital CurrentSince Feb 1, 2020 Accepting new patients
Kona Hospital Past Accepting new patients

Locations

67-1125 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4400

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470441600000",
    "number": "1912265117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-383-6941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 HURST DR",
            "address_2": "STE 130",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "61938",
            "telephone_number": "217-258-5900",
            "fax_number": "217-258-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "VALERIE",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-25",
        "last_updated": "2016-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "63210",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036138867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.