Provider Demographics
NPI:1972587061
Name:RERRI, BERNARD E (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:E
Last Name:RERRI
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 1:938 M L KING DR
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3058
Mailing Address - Country:US
Mailing Address - Phone:618-918-2262
Mailing Address - Fax:618-918-3623
Practice Address - Street 1:938 ML KING DR.
Practice Address - Street 2:
Practice Address - City:CENTRAILIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-918-2262
Practice Address - Fax:618-918-3623
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128561207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042629461OtherUNICARE/GIC
MA486865OtherTUFTS
MA9035874OtherCIGNA
MA223063OtherCONNECTICARE
IL985880OtherMEDICARE PTAN
IL036128561OtherIDHFS
MA042629461OtherPRIVATE HEALTHCARE SYS
MA042629461OtherCONSOLIDATED
MA042629461OtherNORTHEAST HEALTHCARE ALLI
MA36994OtherHEALTH NEW ENGLAND
MA042629461OtherNORTH AMERICAN PREFERRED
MA042629461OtherNORTHEAST HEALTH DIRECT
MA2111942Medicaid
MAJ28584OtherBCBSMA
MA3943917OtherAETNA
MA042629461OtherPLAN VISTA
MA3943917OtherAETNA
MA9035874OtherCIGNA