Gopal Madhav, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036-058991 Issued in IL

Practice address

3900 W 95TH St
Ste 6
Evergreen Park, IL 60805-1901

Phone

(708) 423-7734

Fax

(708) 423-3282

NPI assigned

Jun 12, 2005

Reactivated

Mar 31, 2006

Last updated

Dec 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: gmadhav276183@direct.myadvocateaurora.org

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

{
    "created_epoch": "1118534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1649274119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W 95TH ST",
            "address_2": "STE 6",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051901",
            "telephone_number": "708-423-7734",
            "fax_number": "708-423-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W 95TH ST",
            "address_2": "STE 6",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051901",
            "telephone_number": "708-423-7734",
            "fax_number": "708-423-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADHAV",
        "first_name": "GOPAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-12",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-058991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036058991",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmadhav276183@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "3900 W 95th St",
            "address_2": "Ste 6",
            "city": "Evergreen Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "608051901",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3900 W 95th St",
            "address_2": "Ste 6",
            "city": "Evergreen Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "608051901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Internal Medicine Physician in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.