1972587061 NPI number — BERNARD E. RERRI MD

Table of content: BERNARD E. RERRI MD (NPI 1972587061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972587061 NPI number — BERNARD E. RERRI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RERRI
Provider First Name:
BERNARD
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972587061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
938 M L KING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62801-3058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-918-2262
Provider Business Mailing Address Fax Number:
618-918-3623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
938 ML KING DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAILIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-918-2262
Provider Business Practice Location Address Fax Number:
618-918-3623
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  036128561 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 036128561 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 042629461 . This is a "UNICARE/GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 486865 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9035874 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 223063 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 985880 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036128561 . This is a "IDHFS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "PRIVATE HEALTHCARE SYS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "CONSOLIDATED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "NORTHEAST HEALTHCARE ALLI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 36994 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2111942 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J28584 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3943917 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042629461 . This is a "PLAN VISTA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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