Mohammed Raasiq Ul Iman Gandam, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.164074 Issued in IL

Practice address

1401 E State St
Rockford, IL 61104-2315

Phone

(770) 696-4400

NPI assigned

Mar 26, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Internal Medicine

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rockford Hospitalist Group LLCGroup PAC ID 9830559491, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uw Health Hospital, Rockford, IL, CCN 140228
• University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098

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.

• Rockford Hospitalist Group, LLC

  • Hospitalist Physician
  • Rockford, IL
  • NPI 1750088852
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732
  Care Compare affiliation
• University of Wisconsin Hospitals and Clinics Authority

  • General Acute Care Hospital
  • Madison, WI
  • NPI 1922043744
  Care Compare affiliation

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1417584699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042315",
            "telephone_number": "779-696-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042315",
            "telephone_number": "770-696-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDAM",
        "first_name": "MOHAMMED",
        "middle_name": "RAASIQ UL IMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.164074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Gallant
• Jonathan E Gallas
• Thomas Galli, D.C.
• Paul A Galluzzo, DPM
• Martin A Ganan, RPH
• Amie Gandhi, OD
• Sirisha Dumpeti Ganji, MD
• Lindsay Leigh Gann, DPT
• Margaret Gannon
• Wei Gao, DDS

• Internal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.