NPIMap

Individual provider Active NPI

Gopal N Bhalala, MD

  • Internal Medicine Physician
  • Zion, IL
National Provider Identifier
1669473963
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-072139 Issued in IL
Practice address
2024 Lewis Ave
Zion, IL 60099-1546
Phone
(847) 872-3000
Fax
(847) 872-7202
NPI assigned
Aug 9, 2005
Reactivated
Mar 27, 2006
Last updated
Sep 10, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

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 036-072139 IL Primary

Addresses

Primary practice location

2024 Lewis Ave
Zion, IL 60099-1546

Mailing address

2024 Lewis Ave
Zion, IL 60099-1546
Phone (847) 872-3000

Other identifiers 1

IdentifierTypeStateIssuer
036072139MedicaidIL

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
I20080805000396 IL Practitioner - Internal Medicine 9739253030 Reassigns benefits to 2 organizations
Practice locations: Libertyville, IL; Waukegan, IL; Zion, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vital Signs Wellness LLCGroup PAC ID 4183958978, 4 clinicians
Gopal N Bhalala M.D..LLCGroup PAC ID 9638437692, 2 clinicians

Practice addresses (Care Compare)

Schaumburg, IL 60194
Phone (847) 444-9038

2024 Lewis Ave
Zion, IL 60099-1546
Phone (847) 872-5911

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-072139ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vital Signs Wellness, LLC CurrentSince Mar 1, 2022 Accepting new patients
Gopal N. Bhalala, M.D..LLC CurrentSince Jan 1, 2018 Accepting new patients

Locations

2024 Lewis Ave
Zion, IL 60099
Phone (847) 872-3000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EJABCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/EJABCA/Endpoint/EJABCA

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.

Hospital & facility affiliations 7

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189382400000",
    "number": "1669473963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 LEWIS AVE",
            "city": "ZION",
            "state": "IL",
            "postal_code": "600991546",
            "telephone_number": "847-872-3000",
            "fax_number": "847-872-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 LEWIS AVE",
            "city": "ZION",
            "state": "IL",
            "postal_code": "600991546",
            "telephone_number": "847-872-3000",
            "fax_number": "847-872-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHALALA",
        "first_name": "GOPAL",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-09-10",
        "deactivation_date": "2006-03-23",
        "reactivation_date": "2006-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-072139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072139",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zion, IL

Sources for this page

Verify at the official NPI Registry.