Individual provider Active NPI

Stephanie Ann Gorham II, MD

  • Family Medicine Physician
  • Belvidere, IL
National Provider Identifier
1023239258
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036123479 Issued in IL
Practice address
1700 Henry Luckow LN
Belvidere, IL 61008
Phone
(779) 696-8650
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036123479 IL Primary

Addresses

Primary practice location

1700 Henry Luckow LN
Belvidere, IL 61008

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgorham911964@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20091104000153 IL Practitioner - Family Practice 7618015173 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1700 Henry Luckow LN
Belvidere, IL 61008-1702
Phone (779) 696-8650

2404 Charles St
Rockford, IL 61108-1602
Phone (779) 696-7910

3505 N Bell School Rd
Rockford, IL 61114-6624
Phone (779) 696-0300

3535 N Bell School Rd
Regional Cancer Center
Rockford, IL 61114-6624
Phone (779) 696-9400

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as group
Quality
83.2
Promoting interoperability
77
Improvement activities
40
Cost
71.7

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Oct 26, 2009 Accepting new patients
Swedishamerican Hospital CurrentSince Oct 26, 2009 Accepting new patients
Swedishamerican Hospital Family Medicine Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1700 Henry Luckow Ln
Belvidere, IL 61008
Phone (779) 696-8650

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

Interoperability endpoints

  • Direct secure messaging: sgorham911964@direct.uwhealth.org

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1023239258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150",
            "fax_number": "779-696-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HENRY LUCKOW LN",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "61008",
            "telephone_number": "779-696-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORHAM",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036123479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgorham911964@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1700 Henry Luckow Ln",
            "city": "Belvidere",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belvidere, IL

Sources for this page

Verify at the official NPI Registry.