Gopinathan Gangadharan Nambiar

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036142874 Issued in IL

Practice address

2901 Old Jacksonville Rd
Springfield, IL 62704-7437

Phone

(217) 698-9722

Fax

(217) 391-0392

NPI assigned

May 7, 2015

Last updated

Jul 16, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1619349578

  Pediatric Gastroenterology

  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1740227131
  NPD (past)

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1013395250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 N State Of Franklin Rd Ste 400E",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046089",
            "country_code": "US",
            "telephone_number": "423-431-4946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANGADHARAN NAMBIAR",
        "first_name": "GOPINATHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-07",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "64787",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036142874",
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TN",
            "license": "64787",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Ellene Gallivan, NP-C
• Delores A Gallo, CRNA
• Katherine L Galloway, MSW, LSW
• Janice R. Gambach, LCSW
• Shyam Kiran Gandam Venkata, MD
• Avani Ganta, M.B.B.S
• Zhenqiang Gao, M.D.
• Siva Ram Garapati, MD
• Lauren Nicole Garbe, MD
• Carlos Garcia, M.D

• Pediatrics Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.