Lourdes M Cruz, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036096484 Issued in IL

Practice address

20613 N Broad St
Suite B
Carlinville, IL 62626-3717

Phone

(217) 854-3881

Fax

(217) 854-3894

NPI assigned

Apr 22, 2006

Last updated

Dec 12, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1932165537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20613 N BROAD ST",
            "address_2": "SUITE B",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626263717",
            "telephone_number": "217-854-3881",
            "fax_number": "217-854-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20613 N BROAD ST",
            "address_2": "SUITE B",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626263717",
            "telephone_number": "217-854-3881",
            "fax_number": "217-854-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "LOURDES",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036096484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096484",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kamal K Chopra, MD
• Crystal Corso, LPC
• Cottages at Carlinville, Inc
• Covenant Care Midwest, Inc (Friendship Home)
• Makinze DC Cox
• Hannah Marie Davidson, LCPC
• Peter Gordon Denby, DDS
• Parth Desai
• Mary Elizabeth Devries, APRN, NP
• Carrie Downs, PT

• Family Medicine Physician in Carlinville, IL
• Providers in Carlinville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.

Verify at the official NPI Registry.