Individual provider Active NPI

Gabriel C Fuqua, M.D.

  • Psychiatry Physician
  • Woodstock, IL
National Provider Identifier
1497198832
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036142096 Issued in IL
Practice address
3701 Doty Rd
Woodstock, IL 60098
Phone
(815) 338-6600
Fax
(815) 206-5376
NPI assigned
Apr 16, 2013
Last updated
Dec 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 036142096 IL Primary

Addresses

Primary practice location

3701 Doty Rd
Woodstock, IL 60098

Mailing address

3701 Doty Rd
Woodstock, IL 60098-7509
Phone (815) 338-6600

Other practice location 1

4802 10th Avenue
Maimonides Medical Center
Brooklyn, NY 11219
Phone (718) 283-6879

Other practice location 2

4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone (815) 338-6600

Other practice location 3

10400 Haligus Rd
Huntley, IL 60142-9553
Phone (815) 338-6600

Other practice location 4

10350 Haligus Rd Ste 200
Huntley, IL 60142-9545
Phone (815) 338-6600

Other identifiers 1

IdentifierTypeStateIssuer
036142096OtherILSTATE LICENSE

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
I20170810001622 IL Practitioner - Psychiatry 1254602196 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

10350 Haligus Rd
Huntley, IL 60142-9585

10400 Haligus Rd
Huntley, IL 60142-9553
Phone (815) 356-2323

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

3701 Doty Rd
Woodstock, IL 60098-7509
Phone (815) 206-3400

3707 Doty Rd
Woodstock, IL 60098-7530

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4874

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

10350 Haligus Rd
Ste 200
Huntley, IL 60142

10400 Haligus Rd
Huntley, IL 60142
Phone (224) 654-0000

11650 S State Route 47
Huntley, IL 60142
Phone (847) 802-7300

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

3701 Doty Rd
Woodstock, IL 60098
Phone (815) 334-3170

Organizations & group practices 2

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 3

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": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1497198832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 DOTY RD",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987509",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 DOTY RD",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "60098",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 10th Avenue",
            "address_2": "Maimonides Medical Center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11219",
            "country_code": "US",
            "telephone_number": "718-283-6879",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 W Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600508409",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10400 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429553",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 Haligus Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429545",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUQUA",
        "first_name": "GABRIEL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-16",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036142096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036142096",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, IL

Sources for this page

Verify at the official NPI Registry.