NPIMap

Individual provider Active NPI

Anthony L Sandiego, MD

  • Surgery Physician
  • Gibson City, IL
National Provider Identifier
1215935895
Registry record updated Dec 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036104575 Issued in IL
Practice address
1 Doctors Park
Gibson City, IL 60936-2000
Phone
(217) 784-4297
Fax
(217) 784-4697
NPI assigned
Jul 8, 2005
Last updated
Dec 21, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036104575 IL Primary

Addresses

Primary practice location

1 Doctors Park
Gibson City, IL 60936-2000

Mailing address

1 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4297

Other identifiers 3

IdentifierTypeStateIssuer
370647938OtherFEIN
02727758OtherILBLUE CROSS/BLUE SHIELD
036104575MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100728001142 IL Practitioner - General Surgery 3072646959 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4297

1120 N Melvin St
Gibson City, IL 60936-1477

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

3 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4030

4 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4251

7 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy65
Hernia repair - groin (open)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux71
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Aug 1, 2012 Accepting new patients
Gibson Community Hospital Association CurrentSince Aug 1, 2012 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

1 Doctors Park
Gibson City, IL 60936
Phone (217) 784-2808

705 S Dixie Hwy
Hoopeston, IL 60942
Phone (217) 283-5530

Interoperability endpoints

  • Direct secure messaging: anthony.sandiego.p24@direct.gapho.nextgenshare.com

Organizations & group practices 4

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.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1215935895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609362000",
            "telephone_number": "217-784-4297",
            "fax_number": "217-784-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609362000",
            "telephone_number": "217-784-4297",
            "fax_number": "217-784-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDIEGO",
        "first_name": "ANTHONY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036104575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "370647938",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "02727758",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104575",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gibson City, IL

Sources for this page

Verify at the official NPI Registry.