Individual provider Active NPI

Evan Hayward Goulding, M.D., PH.D.

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1063645315
Registry record updated Jan 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036.126710 Issued in IL
Practice address
446 E Ontario St Ste 7-100
Chicago, IL 60611-4418
Phone
(312) 695-5060
NPI assigned
Sep 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A64149 CA
Psychiatry Physician 2084P0800X 036.126710 IL Primary

Addresses

Primary practice location

446 E Ontario St Ste 7-100
Chicago, IL 60611-4418

Mailing address

446 E Ontario St Ste 7-100
Chicago, IL 60611-4418
Phone (312) 695-5060

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
I20120224000039 IL Practitioner - PsychiatryPractitioner - Addiction Medicine 8224175112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Addiction Medicine
Education
University of California, San Francisco School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1333 W Belmont Ave
Chicago, IL 60657-5785

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

676 N Saint Clair
Chicago, IL 60611-2927

676 N Saint Clair St
Chicago, IL 60611-2927

737 N Michigan Ave
Chicago, IL 60611-2615
Phone (847) 582-2104

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.126710ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jan 1, 2012 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jan 1, 2012 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

446 E Ontario St
Ste 7100
Chicago, IL 60611
Phone (312) 926-8058

680 N Lake Shore Dr
Ste 100
Chicago, IL 60611
Phone (312) 288-6420

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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": "1251849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1063645315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 E ONTARIO ST STE 7-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114418",
            "telephone_number": "312-695-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 E ONTARIO ST STE 7-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114418",
            "telephone_number": "312-695-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULDING",
        "first_name": "EVAN",
        "middle_name": "HAYWARD",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-02",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A64149",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.126710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.