Individual provider Active NPI

Brandon R. Gumbiner, DPM

  • Foot & Ankle Surgery Podiatrist
  • Dixon, IL
National Provider Identifier
1154583177
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016005377 Issued in IL
Practice address
215 E 1St St Ste 310
Dixon, IL 61021
Phone
(815) 285-5801
Fax
(815) 285-5699
NPI assigned
Jun 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 016005377 IL Primary
Podiatrist 213E00000X 07001081 IN

Addresses

Primary practice location

215 E 1St St Ste 310
Dixon, IL 61021

Mailing address

215 E 1St St Ste 310
Dixon, IL 61021-3190
Phone (815) 285-5801

Other identifiers 3

IdentifierTypeStateIssuer
016005377MedicaidIL
508770006OtherINMEDICARE
F400482004OtherILMEDICARE PTAN

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110829000036 IL Practitioner - Podiatry 6305979170 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2007
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)

215 E 1St St
Dixon, IL 61021-3166
Phone (815) 288-5531

403 E 1St St
Dixon, IL 61021-3116
Phone (815) 288-5531

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

Hospital & facility affiliations

  • Osf Saint Katharine Medical Center Hospital, Dixon, IL, CCN 140012
  • CGH Medical Center Hospital, Sterling, IL, CCN 140043

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue118
Removal of skin lesions1-10
Removal of nail tissue450
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07001081INMDPodiatrist
016005377ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Katherine Shaw Bethea Hospital CurrentSince Jul 12, 2023 Accepting new patients
KSB Medical Group, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 16, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Major Hospital Past Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

215 E 1st St
Ste 310
Dixon, IL 61021
Phone (815) 285-5801

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

403 E 1st St
Dixon, IL 61021
Phone (815) 285-5629

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

215 E 1st St
Dixon, IL 61021
Phone (815) 285-5591

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

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

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1154583177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E 1ST ST STE 310",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213190",
            "telephone_number": "815-285-5801",
            "fax_number": "815-285-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 1ST ST STE 310",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-285-5801",
            "fax_number": "815-285-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUMBINER",
        "first_name": "BRANDON",
        "middle_name": "R.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005377",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07001081",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005377",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "508770006",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "F400482004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.