Individual provider Active NPI

Gowri Subramaniyan, MD

  • Family Medicine Physician
  • Minot, ND
National Provider Identifier
1295175438
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
RL12766 Issued in ND
Practice address
1201 11TH Ave SW
Minot, ND 58701-4207
Phone
(701) 858-6778
Fax
(701) 858-6811
NPI assigned
Jul 2, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RL12766 ND Primary

Addresses

Primary practice location

1201 11TH Ave SW
Minot, ND 58701-4207

Mailing address

1201 11TH Ave SW
Minot, ND 58701-4207
Phone (701) 858-6778

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
I20161027002449 IL Practitioner - Family Practice 6103058284 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians
Proctor Health SystemsGroup PAC ID 3476440173, 131 clinicians

Practice addresses (Care Compare)

3915 Barring Trce
Peoria, IL 61615-2500
Phone (309) 689-3030

5401 N Knoxville Ave
Suite 400
Peoria, IL 61614-5021
Phone (309) 691-6610

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

6831 N Peartree LN
Peoria, IL 61615-2472
Phone (309) 691-1250

8914 N Knoxville Ave
Medpointe Peoria
Peoria, IL 61615-1410
Phone (309) 691-9110

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois Family Medicine CurrentSince Aug 31, 2016 Accepting new patients
Proctor Health Systems Family Medicine Current Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Aug 31, 2016 Accepting new patients
Proctor Health Systems Family Medicine CurrentSince Aug 31, 2016 Accepting new patients
Carle Health Care Incorporated Family Medicine CurrentSince Jan 1, 2026 Accepting new patients
Proctor Health Systems CurrentSince Aug 31, 2016 Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

2535 E Washington St
East Peoria, IL 61611
Phone (309) 694-6464

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

9010 N Allen Rd
Ste J
Peoria, IL 61615
Phone (309) 495-8500

6831 N Peartree Ln
Peoria, IL 61615
Phone (309) 691-1250

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

3915 Barring Trce
Peoria, IL 61615
Phone (309) 689-3030

8914 N Knoxville Ave
Peoria, IL 61615
Phone (309) 691-9110

815 Main St
Ste A1
Peoria, IL 61602

1120 E War Memorial Dr
Peoria Hts, IL 61616
Phone (309) 685-1774

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

Interoperability endpoints

  • Direct secure messaging: gsubramaniyanmd388541@carlehiedirect.net

Organizations & group practices 8

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 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": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1295175438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 11TH AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014207",
            "telephone_number": "701-858-6778",
            "fax_number": "701-858-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 11TH AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014207",
            "telephone_number": "701-858-6778",
            "fax_number": "701-858-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBRAMANIYAN",
        "first_name": "GOWRI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-02",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "RL12766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.