Eliyazar Gaddam, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

35.127156 Issued in OH

Practice address

951 Commerce Pkwy
Suite 100
Lima, OH 45804-4040

Phone

(419) 224-5915

Fax

(419) 224-5918

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

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 2

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Friedell Clinic, S. C.Group PAC ID 2567366164, 24 clinicians

Foundation for Outreach ServicesGroup PAC ID 3375507163, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson Park Hospital Hospital, Chicago, IL, CCN 140177
• Humboldt Park Health Hospital, Chicago, IL, CCN 140206
• St Bernard Hospital Hospital, Chicago, IL, CCN 140103
• Loretto Hospital Hospital, Chicago, IL, CCN 140083

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eliyazar.gaddam@loretto.medalliesdirect.net
• Direct secure messaging: eliyazargaddam@jph.medalliesdirect.net

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.

• Foundation for Outreach Services

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1316350242
  Medicare reassignment Care Compare group NPD
• Friedell Clinic, S. C.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1306854021
  Medicare reassignment Care Compare group NPD
• Metro Physicians & Specialists

  • Cardiovascular Disease Physician
  • Chicago, IL
  • NPI 1699723403
  Medicare reassignment NPD Authorized official
• Cal Devon Urgent Care Inc

  • Diagnostic Radiology Physician
  • Morton Grove, IL
  • NPI 1104940618
  Medicare reassignment NPD
• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD
• Touhy Diagnostic at Home, LLC

  • Diagnostic Radiology Physician
  • Des Plaines, IL
  • NPI 1518042548
  Medicare reassignment NPD
• Jackson Park Hospital Foundation

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497750699
  NPD
• Loretto Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1447280284
  NPD
• Northshore Imaging Services Inc

  • Mobile Mammography Clinic/Center
  • Mount Prospect, IL
  • NPI 1801047030
  NPD
• Northshore Ultrasound Services Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Mount Prospect, IL
  • NPI 1164059572
  NPD
• RMH Pathologists, LTD

  • Anatomic Pathology Physician
  • Rockford, IL
  • NPI 1184671992
  NPD
• Touhy Diagnostic at Home LLC

  • Mobile Radiology Clinic/Center
  • Schererville, IN
  • NPI 1841621232
  NPD

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

• Humboldt Park Health

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1972594877
  Care Compare affiliation
• Jackson Park Hospital Foundation

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497750699
  Care Compare affiliation
• Loretto Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1447280284
  Care Compare affiliation
• St. Bernard Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1811034291
  Care Compare affiliation

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1073561858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 COMMERCE PKWY",
            "address_2": "SUITE 101",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458044040",
            "telephone_number": "419-998-4575",
            "fax_number": "419-998-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 COMMERCE PKWY",
            "address_2": "SUITE 100",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458044040",
            "telephone_number": "419-224-5915",
            "fax_number": "419-224-5918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 N Rockton Ave",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611033600",
            "country_code": "US",
            "telephone_number": "815-971-2200",
            "fax_number": "815-971-9097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8201 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611142300",
            "country_code": "US",
            "telephone_number": "815-971-2200",
            "fax_number": "815-971-9097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GADDAM",
        "first_name": "ELIYAZAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35.127156",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036083544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073561858",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083544",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylie Fuhrhop
• Frank E Fumich, M.D.
• Christopher Fusillo, PCC
• Kaitlynn Fuson
• Diane Marie Gable, LISW-S
• Philip Scott Gafford, MD
• Christian F Gaissmaier, MD
• Galahadd's Quest LLC (Reichardt Family Practice)
• Stephanie Gallagher
• Douglas Gallaspie Jr.

• Cardiovascular Disease Physician in Lima, OH
• Providers in Lima, OH by specialty
• Cardiovascular Disease Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.