NPIMap

Organization Active NPI

Gabriels Pride Pediatrics

  • Pediatrics Physician
  • O'Fallon, IL
National Provider Identifier
1124285028
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036095488 Issued in IL
Legal business name
GABRIELS PRIDE PEDIATRICS
Practice address
1337 Park Plaza Drive
Suite 1
Ofallon, IL 62269-1777
Phone
(618) 624-7391
Fax
(618) 624-7392
NPI assigned
May 19, 2008
Last updated
May 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Authorized official

Name
Dr. Thomas Edmund Levvaulh, MD
Title
MD President Owner
Phone
(618) 624-7391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 036095488 IL Primary

Addresses

Primary practice location

1337 Park Plaza Drive
Suite 1
Ofallon, IL 62269-1777

Mailing address

1337 Park Plaza Drive
Suite 1
Ofallon, IL 62269-1777
Phone (618) 624-7391

National Provider Directory

National Provider Directory

Locations

1337 Park Plaza Dr
Ste 1
O Fallon, IL 62269
Phone (618) 624-7391

NPI Registry JSON

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1124285028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 PARK PLAZA DRIVE",
            "address_2": "SUITE 1",
            "city": "OFALLON",
            "state": "IL",
            "postal_code": "622691777",
            "telephone_number": "618-624-7391",
            "fax_number": "618-624-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 PARK PLAZA DRIVE",
            "address_2": "SUITE 1",
            "city": "OFALLON",
            "state": "IL",
            "postal_code": "622691777",
            "telephone_number": "618-624-7391",
            "fax_number": "618-624-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABRIELS PRIDE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "LEVVAULH",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "EDMUND",
        "authorized_official_title_or_position": "MD PRESIDENT OWNER",
        "authorized_official_telephone_number": "618-624-7391",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036095488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.