Active NPI
Melvin J Goldstein, M.D.
- Gastroenterology Physician
- Chicago, IL
National Provider Identifier
1376531400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 036038943
- Practice address
- 676 N Saint Clair St
Suite 1525
Chicago, IL 60611-2927 - Phone
- (312) 337-1556
- Fax
- (312) 266-0478
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 036038943 | IL | Primary |
Addresses
Primary practice location
676 N Saint Clair St
Suite 1525
Chicago, IL 60611-2927
Mailing address
PO Box 388320
Chicago, IL 60638-8320
Phone (773) 767-8283
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036038943 | Medicaid | IL | |
| 21601042 | Other | IL | BLUE SHIELD |
| 111528598 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251244800000",
"number": "1376531400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 388320",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606388320",
"telephone_number": "773-767-8283",
"fax_number": "773-767-8320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "676 N SAINT CLAIR ST",
"address_2": "SUITE 1525",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112927",
"telephone_number": "312-337-1556",
"fax_number": "312-266-0478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSTEIN",
"first_name": "MELVIN",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2009-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "IL",
"license": "036038943",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036038943",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "21601042",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "111528598",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.