NPIMap

Organization Active NPI

Gateway Family Services of Illinois

  • Adolescent and Children Mental Health Clinic/Center
  • Potomac, IL
National Provider Identifier
1609514801
Registry record updated Sep 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
GATEWAY FAMILY SERVICES OF ILLINOIS
Practice address
7757 US Route 136
Potomac, IL 61865-3047
Phone
(217) 488-8006
Fax
(217) 987-6386
NPI assigned
May 26, 2022
Last updated
Sep 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2024

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

Authorized official

Name
Michael RemoleNPI 1861918492
Title
Ceo/President
Phone
(217) 488-8006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU

Addresses

Primary practice location

7757 US Route 136
Potomac, IL 61865-3047

Mailing address

7757 US Route 136
Potomac, IL 61865-3047
Phone (217) 488-8006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250618002481 IL Part B Supplier - Clinic/Group Practice 6709397433 Receives reassigned benefits from 2 practitioners
Practice locations: Potomac, IL

National Provider Directory

National Provider Directory
Tax ID family
Gateway Family Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726876800000",
    "number": "1609514801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7757 US ROUTE 136",
            "city": "POTOMAC",
            "state": "IL",
            "postal_code": "618653047",
            "telephone_number": "217-488-8006",
            "fax_number": "217-987-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7757 US ROUTE 136",
            "city": "POTOMAC",
            "state": "IL",
            "postal_code": "618653047",
            "telephone_number": "217-488-8006",
            "fax_number": "217-987-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY FAMILY SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2024-09-21",
        "certification_date": "2024-09-21",
        "status": "A",
        "authorized_official_last_name": "REMOLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "217-488-8006"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Potomac, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.