NPIMap

Individual provider Active NPI

Peter Charles Roumeliotis, MD

  • Internal Medicine Physician
  • Morris, IL
National Provider Identifier
1942280326
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036085485 Issued in IL
Practice address
1300 W. Dresden Drive
Morris, IL 60450
Phone
(815) 942-5200
Fax
(815) 942-5330
NPI assigned
Jan 20, 2006
Last updated
Jun 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036085485 IL Primary

Addresses

Primary practice location

1300 W. Dresden Drive
Morris, IL 60450

Mailing address

725 School St Ste a
Morris, IL 60450-1207
Phone (815) 941-9124

Other practice location 1

1802 N Division St
Suite 703
Morris, IL 60450-1182
Phone (815) 941-8000

Other identifiers 3

IdentifierTypeStateIssuer
003204876OtherILBLUE CROSS
020475OtherILHEALTH ALLIANCE
036085485MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060628000018 IL Practitioner - Internal Medicine 9436161924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Morris HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

1802 N Division St
Suite 703
Morris, IL 60450-3104
Phone (815) 942-4506

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
David G Vermillion M D P C Internal Medicine Current Accepting new patients
Morris Hospital CurrentSince Oct 1, 2015 Accepting new patients
Morris Hospital CurrentSince Oct 1, 2015 Accepting new patients
Morris Hospital Current Accepting new patients
Morris Hospital Past Accepting new patients
Apache Interpretations SC Internal Medicine Past Accepting new patients

Locations

580 Sycamore St
Marseilles, IL 61341
Phone (815) 795-2122

1300 Dresden Dr
Morris, IL 60450
Phone (815) 942-5200

150 W High St
Morris, IL 60450
Phone (815) 942-2129

1802 N Division St
Ste 703
Morris, IL 60450
Phone (815) 941-8000

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: peter.roumeliotis.1@14307.direct.athenahealth.com
  • Direct secure messaging: peter.roumeliotis@direct-address.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arcadia Care MorrisMorris, IL, CCN 145623 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2022
Feb 1, 2022
Serenity Estates of MorrisMorris, IL, CCN 146077 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2024
Aug 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1942280326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-941-9124",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W. DRESDEN DRIVE",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "60450",
            "telephone_number": "815-942-5200",
            "fax_number": "815-942-5330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 N Division St",
            "address_2": "Suite 703",
            "address_purpose": "LOCATION",
            "city": "Morris",
            "state": "IL",
            "postal_code": "604501182",
            "country_code": "US",
            "telephone_number": "815-941-8000",
            "fax_number": "815-705-1712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUMELIOTIS",
        "first_name": "PETER",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036085485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "003204876",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "020475",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085485",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

Verify at the official NPI Registry.