Individual provider Active NPI

Michael T. Gillam, M.D.

  • Emergency Medicine Physician
  • Evanston, IL
National Provider Identifier
1013092188
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036099418 Issued in IL
Practice address
2650 Ridge Ave
Emergency Medicine RM G909
Evanston, IL 60201-1718
Phone
(847) 570-2114
Fax
(847) 570-1223
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036099418 IL Primary
Emergency Medicine Physician 207P00000X 0101283367 VA

Addresses

Primary practice location

2650 Ridge Ave
Emergency Medicine RM G909
Evanston, IL 60201-1718

Mailing address

2650 Ridge Ave
Evanston, IL 60201-1700
Phone (847) 570-1644

Other practice location 1

7042 Little River Tpke Ste A
Annandale, VA 22003-5973
Phone (703) 343-7125

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address VAExchange@patientfirst.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251015003740 DC Practitioner - Emergency Medicine 4486687464 Reassigns benefits to 1 organization
I20251029000129 VA Practitioner - Emergency Medicine 4486687464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Human Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7042 Little River Tpke
Suite a
Annandale, VA 22003-5973
Phone (703) 343-7125

8110 Midlothian Tpke
North Chesterfield, VA 23235-5116
Phone (804) 320-8160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Richmond Medical Group PLLC CurrentSince Aug 15, 2025 Accepting new patients
Patient First Richmond Medical Group PLLC CurrentSince Aug 15, 2025 Accepting new patients
Endeavor Health Medical Group Emergency Medicine Past Accepting new patients
Endeavor Health Medical Group Past Accepting new patients

Locations

6311 Richmond Hwy
Alexandria, VA 22306
Phone (703) 647-6087

7042 Little River Tpke
Ste A
Annandale, VA 22003
Phone (703) 343-7125

601 Potomac Station Dr NE
Leesburg, VA 20176
Phone (703) 840-1396

8110 Midlothian Tpke
North Chesterfield, VA 23235
Phone (804) 320-8160

Interoperability endpoints

  • Direct secure messaging: vaexchange@patientfirst.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1013092188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "847-570-1644",
            "fax_number": "847-733-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "EMERGENCY MEDICINE RM G909",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2114",
            "fax_number": "847-570-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7042 Little River Tpke Ste A",
            "address_purpose": "LOCATION",
            "city": "Annandale",
            "state": "VA",
            "postal_code": "220035973",
            "country_code": "US",
            "telephone_number": "703-343-7125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLAM",
        "first_name": "MICHAEL",
        "middle_name": "T.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036099418",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101283367",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "VAExchange@patientfirst.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "7042 Little River Tpke Ste A",
            "city": "Annandale",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220035973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.