Individual provider Active NPI

Gina Nicole Guglielmi, DO

  • Neurological Surgery Physician
  • Normal, IL
National Provider Identifier
1285164699
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
036153477 Issued in IL
Practice address
1302 Franklin Ave Ste 2800
Normal, IL 61761-6526
Phone
(309) 268-6300
NPI assigned
Jun 18, 2017
Last updated
Oct 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 125.071056 IL
Neurological Surgery Physician 207T00000X 036153477 IL Primary

Addresses

Primary practice location

1302 Franklin Ave Ste 2800
Normal, IL 61761-6526

Mailing address

611 W Park St
Fapc
Urbana, IL 61801-2500

Other practice location 1

1304 Franklin Ave
Normal, IL 61761-3558
Phone (309) 454-1400

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
I20240712003452 IL Practitioner - Neurosurgery 7113297797 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle West Physician Group IncGroup PAC ID 8921420308, 282 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1302 Franklin Ave
Suite 2500
Normal, IL 61761-6526
Phone (309) 268-2792

2204 Eastland Dr
Bloomington, IL 61704-3567
Phone (309) 663-0222

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion33
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.071056ILMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Jul 1, 2024 Accepting new patients
Carle Eureka Hospital Current Accepting new patients
Carle West Physician Group Inc CurrentSince Jul 1, 2024 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

1302 Franklin Ave
Ste 2800
Normal, IL 61761
Phone (309) 268-6300

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: gguglielmido322085@carlehiedirect.net

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 3

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": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1285164699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 FRANKLIN AVE STE 2800",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616526",
            "telephone_number": "309-268-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1304 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Normal",
            "state": "IL",
            "postal_code": "617613558",
            "country_code": "US",
            "telephone_number": "309-454-1400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUGLIELMI",
        "first_name": "GINA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-18",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "125.071056",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "036153477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.