Active NPI
Jericho Hallare
- Surgery Physician
- Maywood, IL
National Provider Identifier
1992407993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 125081474
- Practice address
- 2160 S. 1St. Avenue BLDG. 105
Suite 2840a
Maywood, IL 60153 - Phone
- (888) 584-7888
- NPI assigned
- Mar 21, 2023
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 125081474 | IL | Primary |
Addresses
Primary practice location
2160 S. 1St. Avenue BLDG. 105
Suite 2840a
Maywood, IL 60153
Mailing address
2160 S. 1St. Avenue BLDG. 105
Suite 2840a
Maywood, IL 60153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1992407993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 S. 1ST. AVENUE BLDG. 105",
"address_2": "SUITE 2840A",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "60153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 S. 1ST. AVENUE BLDG. 105",
"address_2": "SUITE 2840A",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "60153",
"telephone_number": "888-584-7888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLARE",
"first_name": "JERICHO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-21",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "125081474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maywood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.