Individual provider Active NPI

Richard Anthony Valadez, M.D.

  • Urology Physician
  • Rockford, IL
National Provider Identifier
1922088640
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036066868 Issued in IL
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

Updated by the provider on Nov 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
036066868MedicaidIL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040507000991 IL Practitioner - Urology 7810986668

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
United Shockwave Services, LTD. CurrentSince Jan 1, 2004 Accepting new patients
United Shockwave Services, LTD. Urology Current Accepting new patients
United Shockwave Services, LTD. Urology CurrentSince Jan 1, 2004 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.

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

Verify at the official NPI Registry.