Individual provider Active NPI

Melvin J Goldstein, M.D.

  • Gastroenterology Physician
  • Chicago, IL
National Provider Identifier
1376531400
Registry record updated Aug 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036038943 Issued in IL
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

Updated by the provider on Aug 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
036038943MedicaidIL
21601042OtherILBLUE SHIELD
111528598OtherRAILROAD 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.

Verify at the official NPI Registry.