Active NPI
Marianne Gould, PA-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1710937750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-002015
- Practice address
- 1501 S California Ave
Chicago, IL 60608-1732 - Phone
- (773) 257-6770
- NPI assigned
- May 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-002015 | IL | Primary |
Addresses
Primary practice location
1501 S California Ave
Chicago, IL 60608-1732
Mailing address
1501 S California Ave
Chicago, IL 60608-1732
Phone (773) 257-6770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085-002015 | Other | IL | STATE LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-002015 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1710937750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 S CALIFORNIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081732",
"telephone_number": "773-257-6770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S CALIFORNIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081732",
"telephone_number": "773-257-6770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULD",
"first_name": "MARIANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-002015",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "085-002015",
"state": "IL"
}
],
"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 Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.