DR. REYNALDO ELAZEGUI NEPOMUCENO (NPI# 1447283692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447283692 |
| Entity Type | Individual |
| Full Name | DR. REYNALDO ELAZEGUI NEPOMUCENO |
| Credential | M.D. |
| Practice Address |
475 Brown Blvd Suite 106 Bourbonnais IL 60914-2325 |
| Practice Telephone | 8159378786 |
| Practice Fax Number | 8159372067 |
| Mailing Telephone | 8159378786 |
| Mailing Fax Number | 8159372067 |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2010-03-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036079397 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036079397 | 05 |
| Street Address |
475 BROWN BLVD SUITE 106 |
| City | BOURBONNAIS |
| State | IL |
| Zip Code | 60914-2325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669472262 | David Scott Chudwin | Allergy & Immunology | 475 Brown Blvd, Bourbonnais, IL 60914-2325 | 2005-07-26 |
| 1053672832 | Tower Plaza Neurology Sc | Psychiatry & Neurology | 475 Brown Blvd, Suite 101, Bourbonnais, IL 60914-2325 | 2012-06-07 |
| 1821398439 | Tallgrass Cardiology Services Sc | Internal Medicine | 475 Brown Blvd, Suite 103, Bourbonnais, IL 60914-2325 | 2010-10-28 |
| 1205965936 | Michael John Sergeant Sr. | Psychiatry & Neurology | 475 Brown Blvd, Suite 101, Bourbonnais, IL 60914-2325 | 2007-03-06 |
| 1588706733 | Retina of Illinois, S.c. | Ophthalmology | 475 Brown Blvd, Suite 109, Bourbonnais, IL 60914-2325 | 2007-02-13 |
| 1629152574 | Five Apples Inpatient Specialists | Internal Medicine | 475 Brown Blvd, Ste 103, Bourbonnais, IL 60914 | 2006-10-25 |
| 1588779516 | Riverview Pharmacies Inc | Pharmacy | 475 Brown Blvd, Suite 105, Bourbonnais, IL 60914-2325 | 2006-08-20 |
| 1437175148 | Jennifer Pablo Nepomuceno | Family Medicine | 475 Brown Blvd, Suite 106, Bourbonnais, IL 60914-2325 | 2006-07-14 |
| 1962457101 | Hershel Wix Jr. | Internal Medicine | 475 Brown Blvd, Suite 103, Bourbonnais, IL 60914 | 2006-05-24 |
| 1376536615 | Avtar K Razdan I | Pediatrics | 475 Brown Blvd, Suite 102, Bourbonnais, IL 60914-2325 | 2005-08-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648023 | Jacob Daniel Ledesma | Physical Therapist | 588 William R Latham Senior Dr Ste 5, Bourbonnais, IL 60914 | 2020-10-30 |
| 1467069823 | Alicia Nicole Kendra | Nurse Practitioner | Upliftedcare, 482 Main St. Nw, Bourbonnais, IL 60914 | 2020-09-29 |
| 1043860877 | Victor Manuel Vazquez Cervantes | Pharmacist | 2080 No, Il-50, Bourbonnais, IL 60914 | 2019-09-13 |
| 1740843267 | Panoptic Physical Therapy LLC | Physical Medicine & Rehabilitation | 1511 N. Convent St Suite 1000, Bourbonnais, IL 60914 | 2019-04-19 |
| 1770074577 | Colin P Koerner | Physical Therapist | 215 N Convent St Ste 6, Bourbonnais, IL 60914 | 2018-05-29 |
| 1306337340 | Megan Hoskins | Behavior Technician | 3187 N 2420 W Rd., Bourbonnais, IL 60914 | 2018-05-25 |
| 1932600459 | Thomas H George Dds PC | Clinic/Center | 14 Briarcliff Professional Center, Bourbonnais, IL 60914 | 2018-02-21 |
| 1780193904 | Kathleen M Saindon II | Speech-Language Pathologist | 1021 Deer Trail, Bourbonnais, IL 60914 | 2017-09-20 |
| 1457870206 | Janet Mary Notton | Speech-Language Pathologist | 920 W Margaret Lane, Bourbonnais, IL 60914 | 2017-09-13 |
| 1134646375 | Sagar Batish | Student in an Organized Health Care Education/Training Program | 1096 Country Lane, Bourbonnais, IL 60914 | 2017-08-28 |
| Find all providers in zip 60914 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447321849 | Donna C Williams | Family Medicine | 595 William R Latham Sr Dr, Bourbonnais, IL 60914-2319 | 2006-11-10 |
| 1538244389 | Jordan Goodman | Family Medicine | 656 N Convent St Ste B, Bourbonnais, IL 60914-1393 | 2006-10-26 |
| 1750536645 | Rashida Marie Downing | Family Medicine | 400 Riverside Dr, Suite 2800, Bourbonnais, IL 60914-5004 | 2008-11-19 |
| 1801091392 | Megan Patricia Woitas | Family Medicine | 581 William Latham Dr, Suite 102, Bourbonnais, IL 60914-2317 | 2007-06-15 |
| 1083749410 | Nepomuceno Family Practice LLC | Family Medicine | 475 Brown Blvd Ste 106, Bourbonnais, IL 60914-2325 | 2007-02-23 |
| 1073650818 | Midwest Physician Group Ltd | Family Medicine | 595 William R Latham Sr Dr, Bourbonnais, IL 60914-2319 | 2007-01-31 |
| 1710061650 | Ritu Chandan | Family Medicine | 400 Riverside Dr Ste 2800, Bourbonnais, IL 60914 | 2006-10-25 |
| 1093813156 | Saw M Oo | Family Medicine | 370 Larry Power Rd, Suite 2, Bourbonnais, IL 60914-5195 | 2006-09-20 |
| 1437175148 | Jennifer Pablo Nepomuceno | Family Medicine | 475 Brown Blvd, Suite 106, Bourbonnais, IL 60914-2325 | 2006-07-14 |
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|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558969964 | Nicole Kerner | Family Medicine | 310 Brandy Dr, Mackinaw, IL 61755-9707 | 2020-10-16 |
| 1285232991 | Healthy Medical Inc | Family Medicine | 535 N. East St., Suite A, Bradley, IL 60915 | 2020-10-14 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1790390805 | Kimberly Hannah Kupferberg | Family Medicine | 1103 Schaeffer Rd, Long Grove, IL 60047-5153 | 2020-09-15 |
| 1194330977 | Home Doctors for You | Family Medicine | 670 Illinois Blvd, Hoffman Est, IL 60169-3363 | 2020-09-09 |
| 1245844489 | Jovita Zalwango Nassolo | Family Medicine | 116 1/2 N Benton St Apt 2d, Woodstock, IL 60098-3272 | 2020-09-04 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1417565755 | Ghr Total Health and Consulting | Family Medicine | 11336 Mckenna Dr, Frankfort, IL 60423-8096 | 2020-07-22 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| Find all providers with the same taxonomy | ||||
| City | BOURBONNAIS |
| Zip Code | 60914 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.