Chicago Gastroenterology, LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

248000667 Issued in IL

Legal business name

CHICAGO GASTROENTEROLOGY, LLC

Practice address

1431 N Western Ave
Suite 133
Chicago, IL 60622-1797

Phone

(773) 342-6800

Fax

(773) 342-6332

NPI assigned

Sep 17, 2012

Last updated

Sep 17, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Francisco Castillo, M.D.NPI 1205801313

Title

Member

Phone

(847) 708-7496

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Chicago GI Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel F Castillo, M.D.

  • Gastroenterology Physician
  • Chicago, IL
  • NPI 1205801313
  Medicare reassignment Care Compare group NPD Authorized official
• David Jarava, M.D.

  • Gastroenterology Physician
  • Chicago, IL
  • NPI 1295261253
  Medicare reassignment Care Compare group NPD
• Shixiong Liao, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Charlotte, NC
  • NPI 1285698829

  IL

  Medicare reassignment Care Compare group NPD
• Samuel Castillo, M.D.

  • Gastroenterology Physician
  • Chicago, IL
  • NPI 1467503672
  Medicare reassignment NPD

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1366792426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE",
            "address_2": "SUITE 133",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "773-342-6800",
            "fax_number": "773-342-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE",
            "address_2": "SUITE 133",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "773-342-6800",
            "fax_number": "773-342-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FRANCISCO",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-708-7496",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "248000667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205801313",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036063975",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036122662",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "I17297",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1467503672",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "692861",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago GI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Gastroenterology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.