Active NPI
Gopal Srinivasan, M.D.
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1417958133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036-049107
- Practice address
- 1501 S California Ave
Chicago, IL 60608-1732 - Phone
- (773) 257-6476
- NPI assigned
- Aug 3, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 036-049107 | IL | |
| Pediatrics Physician | 208000000X | 036-049107 | IL | Primary |
Addresses
Primary practice location
1501 S California Ave
Chicago, IL 60608-1732
Mailing address
3537 Paysphere Cir
Chicago, IL 60674-0035
Phone (708) 786-2900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-049107-1 | Medicaid | IL |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-049107 | IL | MD | Neonatal-Perinatal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1417958133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3537 PAYSPHERE CIR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606740035",
"telephone_number": "708-786-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S CALIFORNIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081732",
"telephone_number": "773-257-6476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SRINIVASAN",
"first_name": "GOPAL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "IL",
"license": "036-049107",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036-049107",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-049107-1",
"state": "IL"
}
],
"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 May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.