NPIMap

Organization Active NPI

Gude Medical S C

  • Family Medicine Physician
  • Aurora, IL
National Provider Identifier
1710612486
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GUDE MEDICAL S C
Practice address
2302 Twilight Dr
Aurora, IL 60503-6704
Phone
(630) 636-1809
NPI assigned
Jul 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Authorized official

Name
Dr. Charlie Gude, MDNPI 1336202894
Title
President
Phone
(630) 636-1809

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

2302 Twilight Dr
Aurora, IL 60503-6704

Mailing address

2302 Twilight Dr
Aurora, IL 60503-6704
Phone (630) 636-1809

Other identifiers 1

IdentifierTypeStateIssuer
036101250MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220809003181 IL Part B Supplier - Clinic/Group Practice 6406238385 Receives reassigned benefits from 8 practitioners
Practice locations: Aurora, IL; Lisle, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1710612486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 TWILIGHT DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605036704",
            "telephone_number": "630-636-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 TWILIGHT DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605036704",
            "telephone_number": "630-636-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUDE MEDICAL S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "GUDE",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-636-1809",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101250",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.