Individual provider Active NPI

Patrick Brian Gibbons, D.O.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1619282233
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.132207 Issued in IL
Practice address
6500 N Clark St
Chicago, IL 60626-4097
Phone
(773) 388-1600
Fax
(773) 388-8664
NPI assigned
Aug 9, 2010
Last updated
Jul 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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 125057692 IL
Family Medicine Physician 207Q00000X 036.132207 IL Primary

Addresses

Primary practice location

6500 N Clark St
Chicago, IL 60626-4097

Mailing address

6500 N Clark St
Chicago, IL 60626-4097
Phone (773) 388-1600

Other practice location 1

4140 Southwest Highway
Hometown, IL 60456
Phone (708) 422-5700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131115000448 IL Practitioner - Family Practice 5890921126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Associates LTDGroup PAC ID 7416917059, 9 clinicians

Practice addresses (Care Compare)

6840 W Windsor Ave
Berwyn, IL 60402-3441
Phone (708) 484-0042

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.132207ILMDFamily Medicine Physician
125057692ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Brown Health Center Current Accepting new patients
Howard Brown Health Center CurrentSince Aug 1, 2013 Accepting new patients
Howard Brown Health Center CurrentSince Aug 1, 2013 Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

3245 N Halsted St
Chicago, IL 60657
Phone (773) 296-8400

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

6500 N Clark St
Chicago, IL 60626
Phone (773) 681-5033

Organizations & group practices 5

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 2

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": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1619282233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264097",
            "telephone_number": "773-388-1600",
            "fax_number": "708-422-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264097",
            "telephone_number": "773-388-1600",
            "fax_number": "773-388-8664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4140 Southwest Highway",
            "address_purpose": "LOCATION",
            "city": "Hometown",
            "state": "IL",
            "postal_code": "60456",
            "country_code": "US",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "PATRICK",
        "middle_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-09",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125057692",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.132207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.