Individual provider Active NPI

Cynthia Goldman, M.D.

  • Internal Medicine Physician
  • Calumet City, IL
National Provider Identifier
1447246111
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036111093 Issued in IL
Practice address
1600 167TH St
Suite 700
Calumet City, IL 60409-5457
Phone
(708) 832-0947
Fax
(708) 862-8613
NPI assigned
Sep 27, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036111093 IL Primary

Addresses

Primary practice location

1600 167TH St
Suite 700
Calumet City, IL 60409-5457

Mailing address

PO Box 1159
South Holland, IL 60473
Phone (708) 832-0947

Other identifiers 1

IdentifierTypeStateIssuer
036111093MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040903000658 IL Practitioner - Internal Medicine 3476529108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ucm Medical Group Sub LLCGroup PAC ID 4688635337, 101 clinicians

Practice addresses (Care Compare)

1 Ingalls Dr
Harvey, IL 60426-3558
Phone (708) 333-2300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036111093ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ucm Medical Group Sub, LLC Internal Medicine CurrentSince Dec 1, 2021 Accepting new patients
Complete Family Healthcare LTD PastSince May 1, 2013 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

1600 Torrence Ave
Calumet City, IL 60409
Phone (708) 730-1300

1600 167th St
Ste 700
Calumet City, IL 60409
Phone (708) 832-0947

1600 167th St
Ste 500
Calumet City, IL 60409
Phone (708) 868-1170

27702 Network Pl
Chicago, IL 60673

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21705/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1447246111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1159",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "60473",
            "telephone_number": "708-832-0947",
            "fax_number": "708-862-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 167TH ST",
            "address_2": "SUITE 700",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095457",
            "telephone_number": "708-832-0947",
            "fax_number": "708-862-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "CYNTHIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036111093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111093",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet City, IL

Sources for this page

Verify at the official NPI Registry.