Individual provider Active NPI

Gurcharan S Randhawa, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago, IL
National Provider Identifier
1639206535
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036085519 Issued in IL
Practice address
1229 N North Branch St
Suite 210
Chicago, IL 60642-2473
Phone
(312) 939-5090
Fax
(312) 640-4496
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 27214 IA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036085519 IL Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 01038819A IN

Addresses

Primary practice location

1229 N North Branch St
Suite 210
Chicago, IL 60642-2473

Mailing address

1229 N North Branch St
Suite 210
Chicago, IL 60642-2473
Phone (312) 939-5090

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01038819AINMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Keokuk County Health Center Past Accepting new patients
Lake Mi Mobile Doctors P.C. Geriatric Medicine Past Accepting new patients
Mobile Ultrasound LLC Past Accepting new patients
Iowa Rural Surgical Associates, P.C. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1639206535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 N NORTH BRANCH ST",
            "address_2": "SUITE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422473",
            "telephone_number": "312-939-5090",
            "fax_number": "312-640-4496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 N NORTH BRANCH ST",
            "address_2": "SUITE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422473",
            "telephone_number": "312-939-5090",
            "fax_number": "312-640-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDHAWA",
        "first_name": "GURCHARAN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "27214",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036085519",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IN",
            "license": "01038819A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.