Individual provider Active NPI

Tondalaya L. Gamble, MD

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Evanston, IL
National Provider Identifier
1154334209
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
036092816 Issued in IL
Practice address
1000 Central St
Suite 730
Evanston, IL 60201-1777
Phone
(847) 570-2750
Fax
(847) 570-1386
NPI assigned
Aug 13, 2006
Last updated
Oct 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036092816 IL
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 036092816 IL Primary

Addresses

Primary practice location

1000 Central St
Suite 730
Evanston, IL 60201-1777

Mailing address

2650 Ridge Ave
Evanston Hospital
Evanston, IL 60201-1718
Phone (847) 570-2040

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
I20041222000375 IL Practitioner - Obstetrics/Gynecology 0143288167 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2800 W 95TH St
Evergreen, IL 60805-2701
Phone (708) 499-2070

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036092816ILMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Oct 1, 2022 Accepting new patients
Osf Healthcare System CurrentSince Sep 15, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Cook County Current Accepting new patients
Osf Healthcare System CurrentSince Sep 15, 2020 Accepting new patients
Cook County Obstetrics & Gynecology CurrentSince Sep 9, 2015 Accepting new patients
Cook County CurrentSince Sep 9, 2015 Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 1, 2022 Accepting new patients
Advocate North Side Health Network Past Accepting new patients
VHS of Illinois Inc Obstetrics & Gynecology Past Accepting new patients
Endeavor Health Medical Group Past Accepting new patients
Endeavor Health Medical Group Obstetrics & Gynecology Past Accepting new patients
Endeavor Health Clinical Operations Past Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

25706 Network Pl
Chicago, IL 60673

4909 W Division St
Chicago, IL 60651
Phone (773) 854-8000

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444348800000",
    "number": "1154334209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "EVANSTON HOSPITAL",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2040",
            "fax_number": "847-570-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CENTRAL ST",
            "address_2": "SUITE 730",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011777",
            "telephone_number": "847-570-2750",
            "fax_number": "847-570-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBLE",
        "first_name": "TONDALAYA",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2015-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036092816",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "IL",
            "license": "036092816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.