Basic Information
| Provider Information | |||||||||
| NPI: | 1225001811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173833311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 WEST UNIVERSITY AVENUE | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173833311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 09/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MOR5G20 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208600000X | 036051386 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2532177 | 01 | PA | HIGHMARK BLUE SHIELD-WMG | OTHER | 35915 | 01 | MO | HEALTHCARE USA | OTHER | 037225100 | 05 | MD | MEDICAID | 1123050001 | 01 | MO | CIGNA MEDICARE | OTHER | 179373 | 01 | MO | HEALTHLINK | OTHER | 30084779 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 0533210001 | 01 | IL | DMERC | OTHER | I603 | 01 | MO | PRINCIPAL | OTHER | 102528833 | 05 | PA | MEDICAID | 1592722 | 01 | GATEWAY-WMG | OTHER | 2831 | 01 | MO | GHP | OTHER | 416251 | 01 | PA | UPMC-WMG | OTHER | 200025012 | 01 | MO | RAILROAD MEDICARE | OTHER | 09-00307 | 01 | MO | UHC | OTHER | 202362927 | 05 | MO | MEDICAID | 35270 | 01 | MO | BCBS | OTHER | 393227 | 01 | PA | UNISON-WMG | OTHER |