NPIMap

Individual provider Active NPI

Travis Andre Gayles, MD, PHD

  • Hospitalist Physician
  • Joliet, IL
National Provider Identifier
1184850653
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
036.131329 Issued in IL
Practice address
333 Madison Street
Joliet, IL 60435-0000
Phone
(815) 725-7133
Fax
(630) 914-2469
NPI assigned
Jun 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036131329 IL
Hospitalist Physician 208M00000X 036.131329 IL Primary

Addresses

Primary practice location

333 Madison Street
Joliet, IL 60435-0000

Mailing address

1000 Remington Blvd
Suite 100
Bolingbrook, IL 60440-0000
Phone (630) 914-2417

Other identifiers 1

IdentifierTypeStateIssuer
036131329MedicaidIL

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
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
036.131329ILMDHospitalist Physician

NPI Registry JSON

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398124800000",
    "number": "1184850653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BLVD",
            "address_2": "SUITE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400000",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MADISON STREET",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604350000",
            "telephone_number": "815-725-7133",
            "fax_number": "630-914-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYLES",
        "first_name": "TRAVIS",
        "middle_name": "ANDRE",
        "name_prefix": "Mr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2014-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036131329",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036.131329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036131329",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; 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.