NPIMap

Individual provider Active NPI

Matthew Paul Gullone, M.D.

  • Family Medicine Physician
  • Galena, IL
National Provider Identifier
1548290901
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036123588 Issued in IL
Practice address
One Medical Center Dr
Galena, IL 61036
Phone
(815) 777-1340
Fax
(815) 776-7274
NPI assigned
Jul 3, 2006
Last updated
Oct 14, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11013121A IN
Family Medicine Physician 207Q00000X 036123588 IL Primary

Addresses

Primary practice location

One Medical Center Dr
Galena, IL 61036

Mailing address

One Medical Center Dr
Galena, IL 61036
Phone (815) 777-1340

Other identifiers 2

IdentifierTypeStateIssuer
036123588OtherILLICENSE
11013121AOtherINLICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address midwestmedical@midwestmedicalcenter.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090807000395 IL Practitioner - Family Practice 4981789922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Medical CenterGroup PAC ID 5698771848, shared by 3 NPIs, 36 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Galena, IL 61036-8118
Phone (815) 777-1340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11013121AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Medical Center CurrentSince Aug 3, 2009 Accepting new patients
Midwest Medical Center CurrentSince Aug 3, 2009 Accepting new patients
Memorial Hospital of South Bend Past Accepting new patients

Locations

1 Medical Center Dr
Galena, IL 61036
Phone (815) 776-7381

Interoperability endpoints

  • Direct secure messaging: mgullone@midwestmedicalcenter.cernerdirect.com
  • Direct secure messaging: midwestmedical@midwestmedicalcenter.cernerdirect.com

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 6

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1548290901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DR",
            "city": "GALENA",
            "state": "IL",
            "postal_code": "61036",
            "telephone_number": "815-777-1340",
            "fax_number": "815-776-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DR",
            "city": "GALENA",
            "state": "IL",
            "postal_code": "61036",
            "telephone_number": "815-777-1340",
            "fax_number": "815-776-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLONE",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11013121A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036123588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036123588",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "11013121A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "midwestmedical@midwestmedicalcenter.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Midwest Medical Center Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "One Medical Center Dr",
            "city": "Galena",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Galena, IL

Sources for this page

Verify at the official NPI Registry.