Provider Demographics
NPI:1225001811
Name:PEARSON, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:
Practice Address - Street 1:602 WEST UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-383-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR5G20207X00000X
IL036051386208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2532177OtherHIGHMARK BLUE SHIELD-WMG
MO35915OtherHEALTHCARE USA
MD037225100Medicaid
MO1123050001OtherCIGNA MEDICARE
MO179373OtherHEALTHLINK
PA30084779OtherAMERIHEALTH MERCY-WMG
IL0533210001OtherDMERC
MOI603OtherPRINCIPAL
PA102528833Medicaid
1592722OtherGATEWAY-WMG
MO2831OtherGHP
PA416251OtherUPMC-WMG
MO200025012OtherRAILROAD MEDICARE
MO09-00307OtherUHC
MO202362927Medicaid
MO35270OtherBCBS
PA393227OtherUNISON-WMG
MO09-00307OtherUHC
MO35270OtherBCBS
MOI603OtherPRINCIPAL
MO1123050001OtherCIGNA MEDICARE
MO179373OtherHEALTHLINK
MO202362927Medicaid
MO000000555Medicare PIN