NPIMap

Individual provider Active NPI

Mariusz W Gadula, MD

  • Internal Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1548292832
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036088145 Issued in IL
Practice address
4609 W 103Rd St
Oak Lawn, IL 60453-4718
Phone
(708) 425-0070
Fax
(708) 425-0304
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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 036088145 IL Primary

Addresses

Primary practice location

4609 W 103Rd St
Oak Lawn, IL 60453-4718

Mailing address

4609 W 103Rd St
Oak Lawn, IL 60453-4718
Phone (708) 425-0070

Other identifiers 1

IdentifierTypeStateIssuer
036088145MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mgadula275970@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20090408000018 IL Practitioner - Internal Medicine 5496750259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4609 W 103Rd St
Oak Lawn, IL 60453-4718
Phone (708) 425-0070

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036088145ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Internal Medicine Inc. Internal Medicine CurrentSince Apr 1, 2009 Accepting new patients

Locations

4609 W 103rd St
Oak Lawn, IL 60453
Phone (708) 425-0070

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EFCCCA/Endpoint/EFCCCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/EFCCCA

Organizations & group practices 1

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.

Hospital & facility affiliations 9

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1548292832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4609 W 103RD ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534718",
            "telephone_number": "708-425-0070",
            "fax_number": "708-425-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4609 W 103RD ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534718",
            "telephone_number": "708-425-0070",
            "fax_number": "708-425-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADULA",
        "first_name": "MARIUSZ",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036088145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088145",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgadula275970@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4609 W 103rd St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604534718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4609 W 103rd St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604534718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.