Individual provider Active NPI

Gopal Teralandur Raghunath, PT, MS, DPT, CSCS

  • Specialist
  • Buffalo Grove, IL
National Provider Identifier
1073635777
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
070013042 Issued in IL
Practice address
125 E Lake Cook Rd
Suite 209
Buffalo Grove, IL 60089-4356
Phone
(847) 520-3382
Fax
(847) 520-3404
NPI assigned
Apr 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 070013042 IL Primary

Addresses

Primary practice location

125 E Lake Cook Rd
Suite 209
Buffalo Grove, IL 60089-4356

Mailing address

125 E Lake Cook Rd
Ste. 209
Buffalo Grove, IL 60089-4356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Fit for Life Rehab and Fitness Clinic, Inc. CurrentSince Jun 1, 2015 Accepting new patients
Spring Grove Medical Offices LTD PastSince Jan 15, 2007 Accepting new patients
Chicago Functional Neurology Group, LTD. Past Accepting new patients
First Health Assocates, SC PastSince Nov 13, 2000 Accepting new patients
Addison Physical Medicine and Rehabilitation Center LTD. Past Accepting new patients

Locations

611 Rockland Rd
Ste 105
Lake Bluff, IL 60044
Phone (847) 234-4847

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376956800000",
    "number": "1073635777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E LAKE COOK RD",
            "address_2": "STE. 209",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600894356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E LAKE COOK RD",
            "address_2": "SUITE 209",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600894356",
            "telephone_number": "847-520-3382",
            "fax_number": "847-520-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAGHUNATH",
        "first_name": "GOPAL",
        "middle_name": "TERALANDUR",
        "name_prefix": "Mr.",
        "credential": "PT, MS, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2013-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "070013042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; 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.