Sam Gaines, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036057022 Issued in IL

Practice address

Virginia & Franklin Streets
Normal, IL 61761

Phone

(309) 827-4321

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

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

Practice roles

Locations

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Taylorville, IL
  • NPI 1013467646

  Corporate Director

  CMS ownership
• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1225588387

  Corporate Director

  CMS ownership
• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1245759273

  Corporate Director

  CMS ownership
• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1346791167

  Corporate Director

  CMS ownership
• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1861480709

  Corporate Director

  CMS ownership

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.

• Sam Gaines P C

  • Internal Medicine Physician
  • Springfield, IL
  • NPI 1487536314
  Medicare reassignment NPD Authorized official
• Central Illinois Neuroradiology, LTD

  • Specialist
  • Bloomington, IL
  • NPI 1881641371
  NPD (past)
• Prairie Emergency Group, LTD.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Normal, IL
  • NPI 1538184114
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1730115643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 COLBROOK DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627023384",
            "telephone_number": "217-782-9318",
            "fax_number": "217-793-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VIRGINIA & FRANKLIN STREETS",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "61761",
            "telephone_number": "309-827-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAINES",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-057022",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036-057022",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036057022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057022-1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "05721369",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057022",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John D Fulk, P.A.
• Sherry Fulk
• Christopher Alan Funk, PSY.D.
• Brenda J Fuss, N.P.
• Karen Gaber-Patel, DO
• Sonia Gajula, MD
• Laine E Galardini
• Galvan OB/GYN & Associates LLC
• Jeffrey J Galvan, MD
• Erin Elizabeth Gambetti, DPT, ATC

• Internal Medicine Physician in Normal, IL
• Providers in Normal, 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 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.