Gina K. Song, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036104024 Issued in IL

Practice address

2455 Dean St
Suite a
St Charles, IL 60175-4830

Phone

(630) 513-9160

Fax

(630) 513-9617

NPI assigned

Jul 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mrs. Gina M. Song Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844

  Pediatrics

  Medicare reassignment NPD
• Central Dupage Physician Group

  • Orthopaedic Surgery Physician
  • Geneva, IL
  • NPI 1780012344
  NPD
• TLC Medical Group, S.C.

  • Pediatrics Physician
  • Saint Charles, IL
  • NPI 1649334186
  NPD (past)

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261958400000",
    "number": "1386642445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 DEAN ST",
            "address_2": "SUITE A",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "60175",
            "telephone_number": "630-513-9160",
            "fax_number": "630-513-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 DEAN ST",
            "address_2": "SUITE A",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754830",
            "telephone_number": "630-513-9160",
            "fax_number": "630-513-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "GINA",
        "middle_name": "K.",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2009-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036104024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4532123",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104024",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "SONG",
            "middle_name": "M.",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Solace Hospice & Palliative Care, Inc.
• Natalie Soltesz
• Solutions Therapy and Wellness, PLLC
• Patricia A. Somers
• Natalie T Son
• Sanjeev Sood, RPH
• Soothing Connections Counseling PLLC
• Noel Sosa, RBT
• Rienna Sounthala
• Ariana Sowers

• Pediatrics Physician in St Charles, IL
• Providers in St Charles, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.