Individual provider Active NPI

Kelsey Cayun Goon, MD

  • Gynecologic Oncology Physician
  • Chicago, IL
National Provider Identifier
1073132643
Registry record updated Jun 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
036168307 Issued in IL
Practice address
5841 S Maryland Ave # Mc2050
Chicago, IL 60637-1443
Phone
(773) 834-8738
Fax
(773) 702-0840
NPI assigned
Apr 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gynecologic Oncology Physician 207VX0201X 036168307 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave # Mc2050
Chicago, IL 60637-1443

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

Other practice location 1

12631 E 17th Ave, B198-6
Room 4007
Aurora, CO 80045
Phone (303) 724-2052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20200811004043 CO Order and Referring Only - Gynecological OncologyPractitioner - Obstetrics/GynecologyPractitioner - Gynecological Oncology 7416373287

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036168307ILMDGynecologic Oncology Physician

NPI Registry JSON

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

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718496000000",
    "number": "1073132643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC2050",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-834-8738",
            "fax_number": "773-702-0840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12631 E 17th Ave, B198-6",
            "address_2": "Room 4007",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "80045",
            "country_code": "US",
            "telephone_number": "303-724-2052",
            "fax_number": "303-724-2055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOON",
        "first_name": "KELSEY",
        "middle_name": "CAYUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-13",
        "last_updated": "2024-06-16",
        "certification_date": "2024-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "IL",
            "license": "036168307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.