NPIMap

Individual provider Active NPI

Jaleesa Gilbert-Gortman, MD

  • Family Medicine Physician
  • Alton, IL
National Provider Identifier
1710484332
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036154807 Issued in IL
Practice address
2 Memorial Dr Ste 220
Alton, IL 62002-6723
Phone
(618) 474-1723
NPI assigned
Apr 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036154807 IL Primary

Addresses

Primary practice location

2 Memorial Dr Ste 220
Alton, IL 62002-6723

Mailing address

2 Memorial Dr Ste 220
Alton, IL 62002-6723
Phone (618) 474-1723

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20210830001246 IL Practitioner - Family Practice 0648514877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

2 Memorial Dr
Suite 220
Alton, IL 62002-6723
Phone (618) 474-1723

Hospital & facility affiliations

  • Alton Memorial Hospital Hospital, Alton, IL, CCN 140002
  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036154807ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Sep 1, 2021 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Sep 1, 2021 Accepting new patients

Locations

2 Memorial Dr
Ste 220
Alton, IL 62002
Phone (618) 462-6200

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

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 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": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1710484332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEMORIAL DR STE 220",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026723",
            "telephone_number": "618-474-1723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEMORIAL DR STE 220",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026723",
            "telephone_number": "618-474-1723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBERT-GORTMAN",
        "first_name": "JALEESA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036154807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2 Memorial Dr Ste 220",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.