NPIMap

Individual provider Active NPI

Chrysologue Gakuba, M.D.

  • Cardiovascular Disease Physician
  • Pikesville, MD
National Provider Identifier
1619069846
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
D15533 Issued in MD
Practice address
2 Reservoir Cir
Suite 105
Pikesville, MD 21208-6393
Phone
(410) 653-1822
Fax
(410) 653-1857
NPI assigned
Sep 28, 2006
Last updated
Nov 28, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D15533 MD
Cardiovascular Disease Physician 207RC0000X D15533 MD Primary

Addresses

Primary practice location

2 Reservoir Cir
Suite 105
Pikesville, MD 21208-6393

Mailing address

5401 Old Court Rd
Attn: Credentialing
Randallstown, MD 21133-5103
Phone (410) 601-5524

Other identifiers 2

IdentifierTypeStateIssuer
60061888OtherMDR/R MEDICARE PROVIDER #
030281300MedicaidMD

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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Hospital Center, Inc. Past Accepting new patients
Just Heart Cardiovascular Group Inc. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6661/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/136fea15-c667-40bc-9ed2-b1115d62123b/

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.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1619069846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "address_2": "ATTN: CREDENTIALING",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-601-5524",
            "fax_number": "410-601-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 RESERVOIR CIR",
            "address_2": "SUITE 105",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212086393",
            "telephone_number": "410-653-1822",
            "fax_number": "410-653-1857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAKUBA",
        "first_name": "CHRYSOLOGUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D15533",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MD",
            "license": "D15533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MEDICARE PROVIDER #",
            "identifier": "60061888",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030281300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pikesville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.

Verify at the official NPI Registry.