Mary Caitlin Gondek, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209010515 Issued in IL

Practice address

4259 S Berkeley Ave
Chicago, IL 60653-3030

Phone

(773) 268-7600

NPI assigned

Jul 12, 2013

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 names 1

• Miss Mary Caitlin Callahan 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lurie Children'S Medical Group Inc.Group PAC ID 4789597279, 142 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Lurie Children'S Medical Group Inc

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1518064716
  Medicare reassignment Care Compare group NPD
• Lurie Childrens Surgical Foundation Inc

  • Pediatric Surgery Physician
  • Chicago, IL
  • NPI 1356822050
  Medicare reassignment NPD
• Lurie Childrens Pediatric Anesthesia Associates

  • Pediatric Anesthesiology Physician
  • Chicago, IL
  • NPI 1063955078
  NPD

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428883200000",
    "number": "1447691977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4259 S BERKELEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606533030",
            "telephone_number": "773-268-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4259 S BERKELEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606533030",
            "telephone_number": "773-268-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONDEK",
        "first_name": "MARY",
        "middle_name": "CAITLIN",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2015-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "CALLAHAN",
            "middle_name": "CAITLIN",
            "prefix": "MISS",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jerome J Gomolka, DDS
• Georgiana Elizabeth Gomorczak, PA-C
• Prasad B Gonavarum, D.D.S.
• Abina Goncalves, M.D.
• Alexandra Goncharenko, PHARM.D.
• Srikara Dheeraj Reddy Gondhi, MBBS
• Daniel Gondi, MD
• Harsha Canan Gondi, MD
• Stephanie Gondra-Sanabria, MD
• Benchuan Gong, M.D. (CHINA)

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; 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.