NPIMap

Individual provider Active NPI

Jaroslav Isak Goldman, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1639140403
Registry record updated Feb 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-100764 Issued in IL
Practice address
6420 N. California Ave.
Chicago, IL 60645
Phone
(773) 973-6100
Fax
(773) 262-4882
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2014

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 036-100764 IL Primary

Addresses

Primary practice location

6420 N. California Ave.
Chicago, IL 60645

Mailing address

6420 N. California Ave.
Chicago, IL 60645
Phone (773) 973-6100

Other identifiers 1

IdentifierTypeStateIssuer
036-100764MedicaidIL

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
I20070502000433 IL Practitioner - Internal Medicine 3577669837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
GGL Healthcare Associates PLLCGroup PAC ID 0749654572, 5 clinicians

Practice addresses (Care Compare)

9933 Lawler Ave
Suite 440
Skokie, IL 60077-3720
Phone (224) 251-8490

Hospital & facility affiliations

  • Gold Health Home Care Corp Home health agency, Des Plaines, IL, CCN 147749
  • Primecare Home Health Services, Inc Home health agency, Lincolnwood, IL, CCN 147960
  • Unity Hospice of Chicagoland, LLC Hospice, Chicago, IL, CCN 141551
  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Harmony Healthcare & Rehab Ctr Nursing home, Chicago, IL, CCN 145775
  • Astoria Place Living & Rehab Nursing home, Chicago, IL, CCN 145634
  • Carlton at the Lake, the Nursing home, Chicago, IL, CCN 145679
  • Peterson Park Health Care Ctr Nursing home, Chicago, IL, CCN 145838
  • Chalet Living & Rehab Nursing home, Chicago, IL, CCN 145670

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-100764ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
GGL Healthcare Associates, PLLC Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients
Natalia Anikin MD PC Past Accepting new patients

Locations

9933 Lawler Ave
Ste 440
Skokie, IL 60077
Phone (224) 251-8490

342 S Milwaukee Ave
Wheeling, IL 60090
Phone (773) 973-7570

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 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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391731200000",
    "number": "1639140403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 N. CALIFORNIA AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60645",
            "telephone_number": "773-973-6100",
            "fax_number": "773-262-4882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 N. CALIFORNIA AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60645",
            "telephone_number": "773-973-6100",
            "fax_number": "773-262-4882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "JAROSLAV",
        "middle_name": "ISAK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2014-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-100764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-100764",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.