Individual provider Active NPI

Gary Edward Schaffel, M.D.

  • Internal Medicine Physician
  • Lake Forest, IL
National Provider Identifier
1336123884
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036093564 Issued in IL
Practice address
990 S Waukegan Rd Ste 200
Lake Forest, IL 60045-2654
Phone
(847) 234-8100
Fax
(847) 234-8199
NPI assigned
Nov 29, 2005
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036093564 IL Primary

Addresses

Primary practice location

990 S Waukegan Rd Ste 200
Lake Forest, IL 60045-2654

Mailing address

990 S Waukegan Rd Ste 200
Lake Forest, IL 60045-2654
Phone (847) 234-8100

Other identifiers 1

IdentifierTypeStateIssuer
205568397OtherTAX IDENTIFICATION

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
I20070108000253 IL Practitioner - Internal Medicine 6507866027 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forward Focus Medical Care LLCGroup PAC ID 2961402482, 10 clinicians

Practice addresses (Care Compare)

990 S Waukegan Rd
Suite 200
Lake Forest, IL 60045-2655
Phone (847) 234-8100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036093564ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forward Focus Medical Care LLC Internal Medicine CurrentSince Jan 1, 2007 Accepting new patients
North Shore Audiovestibular Lab Inc Past Accepting new patients

Locations

900 N Westmoreland Rd
Ste 104
Lake Forest, IL 60045
Phone (847) 234-5094

990 S Waukegan Rd
#2
Lake Forest, IL 60045
Phone (847) 234-8100

990 S Waukegan Rd
Ste 200
Lake Forest, IL 60045
Phone (847) 234-0555

Organizations & group practices 2

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 4

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1336123884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 S WAUKEGAN RD STE 200",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452654",
            "telephone_number": "847-234-8100",
            "fax_number": "847-234-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 S WAUKEGAN RD STE 200",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452654",
            "telephone_number": "847-234-8100",
            "fax_number": "847-234-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAFFEL",
        "first_name": "GARY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036093564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "205568397",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.