NPIMap

Individual provider Active NPI

Bernardita R Enriquez, M.D.

  • Pediatrics Physician
  • Rock Island, IL
National Provider Identifier
1952395972
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-066809 Issued in IL
Practice address
2750 11TH St
Rock Island, IL 61201-5216
Phone
(563) 327-2100
Fax
(563) 327-2102
NPI assigned
Sep 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-066809 IL Primary
Pediatrics Physician 208000000X 34871 IA
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 036-066809 IL

Addresses

Primary practice location

2750 11TH St
Rock Island, IL 61201-5216

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other identifiers 11

IdentifierTypeStateIssuer
421060724OtherIABILLING TAX ID# FOR CHC
0568980MedicaidIA
421606724A5OtherILJOHN DEERE HEALTH
0568998MedicaidIA
421060724005MedicaidIL
036066809MedicaidIL
8122859OtherILILLINOIS BC/BS
93612OtherIAIOWA BC/BS SEEN IN RI
093469OtherHEALTH ALLIANCE #
336031012OtherILCONTROLLED SUBSTANCE #
IL01A5OtherILJOHN DEERE EDI#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34871IAMDPediatrics Physician
036-066809ILMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients
Community Health Care, Inc. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

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": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1952395972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-327-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 11TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015216",
            "telephone_number": "563-327-2100",
            "fax_number": "563-327-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENRIQUEZ",
        "first_name": "BERNARDITA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-066809",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "34871",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "IL",
            "license": "036-066809",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING TAX ID# FOR CHC",
            "identifier": "421060724",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0568980",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "421606724A5",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0568998",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421060724005",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066809",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS BC/BS",
            "identifier": "8122859",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA BC/BS SEEN IN RI",
            "identifier": "93612",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE #",
            "identifier": "093469",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE #",
            "identifier": "336031012",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE EDI#",
            "identifier": "IL01A5",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.