Active NPI
Martha Mary O'Gorman, M.S.,R.D.,L.D.N.
- Nutritionist
- Dekalb, IL
National Provider Identifier
1497800239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- Practice address
- 125 North First Street
Dekalb, IL 60115-4311 - Phone
- (815) 761-4280
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | IL | Primary |
Addresses
Primary practice location
125 North First Street
Dekalb, IL 60115-4311
Mailing address
121 W Alden PL
Dekalb, IL 60115-4311
Phone (815) 758-0082
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.001087 | IL | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497800239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 W ALDEN PL",
"city": "DEKALB",
"state": "IL",
"postal_code": "601154311",
"telephone_number": "815-758-0082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 NORTH FIRST STREET",
"city": "DEKALB",
"state": "IL",
"postal_code": "601154311",
"telephone_number": "815-761-4280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'GORMAN",
"first_name": "MARTHA",
"middle_name": "MARY",
"name_prefix": "Ms.",
"credential": "M.S.,R.D.,L.D.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.