Active NPI
Richard Anthony Valadez, M.D.
- Urology Physician
- Rockford, IL
National Provider Identifier
1922088640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 036066868
- Practice address
- 351 Executive Pkwy
Rockford, IL 61107-5339 - Phone
- (815) 398-4057
- Fax
- (815) 398-0220
- NPI assigned
- Jan 19, 2006
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | 036066868 | IL | Primary |
Addresses
Primary practice location
351 Executive Pkwy
Rockford, IL 61107-5339
Mailing address
351 Executive Pkwy
Rockford, IL 61107-5339
Phone (815) 398-4057
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036066868 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040507000991 | IL | Practitioner - Urology | 7810986668 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Shockwave Services, LTD. | Current | Accepting new patients | |
| United Shockwave Services, LTD. | Urology | Current | Accepting new patients |
| United Shockwave Services, LTD. | Urology | Current | Accepting new patients |
Locations
1875 W Dempster St
Ste G04
Park Ridge, IL 60068
Phone (630) 684-9361
351 Executive Pkwy
Rockford, IL 61107
Phone (815) 398-4057
200 E Fairman Ave
Watseka, IL 60970
Phone (815) 432-5201
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 and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- La Grange, IL
- NPI 1336526219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258588800000",
"number": "1922088640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 EXECUTIVE PKWY",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075339",
"telephone_number": "815-398-4057",
"fax_number": "815-398-0220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 EXECUTIVE PKWY",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075339",
"telephone_number": "815-398-4057",
"fax_number": "815-398-0220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALADEZ",
"first_name": "RICHARD",
"middle_name": "ANTHONY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2009-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "036066868",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036066868",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.