Gorantla Govindaiah, M.D., S.C.

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

GORANTLA GOVINDAIAH, M.D., S.C.

Practice address

4366 Kennedy Dr
Suite B
East Moline, IL 61244-4288

Phone

(309) 796-1510

Fax

(309) 796-1565

NPI assigned

May 10, 2007

Last updated

May 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gorantla Govindaiah, MD

Title

Owner

Phone

(309) 796-1510

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sujatha Govindaiah, MD

  • Specialist
  • East Moline, IL
  • NPI 1649268053
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1023222502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4366 KENNEDY DR",
            "address_2": "SUITE B",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444288",
            "telephone_number": "309-796-1510",
            "fax_number": "309-796-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4366 KENNEDY DR",
            "address_2": "SUITE B",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444288",
            "telephone_number": "309-796-1510",
            "fax_number": "309-796-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORANTLA GOVINDAIAH, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "GOVINDAIAH",
        "authorized_official_first_name": "GORANTLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-796-1510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036049003",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "98669",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "263500",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8100279",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "K44585",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "010063712",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Garber, M.S. SLP-CFY
• Stephanie Garner, PT, DPT, CSCS
• Ellen Garrity, LPC
• Genesis Health System (Genesis Health Group)
• Genesis Health System (Genesis Health Group)
• Camryn Gosch
• Kara Gossen, PHARMD
• Sujatha Govindaiah, MD
• Alesia Jean Grice-Dyer, PSYD, LPC, RN
• Amy Guerrero-Hattem

• Health Service Clinic/Center in East Moline, IL
• Providers in East Moline, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.