Individual provider Active NPI

Constantine Godellas, M.D.

  • Surgery Physician
  • Maywood, IL
National Provider Identifier
1740251222
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036093866 Issued in IL
Practice address
2160 S 1St Ave
Department of Surgery, BLDG. 110
Maywood, IL 60153-3328
Phone
(708) 327-3430
Fax
(708) 327-3565
NPI assigned
Jan 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology Physician 2086X0206X 036093866 IL
Surgery Physician 208600000X 036093866 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Department of Surgery, BLDG. 110
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Department of Surgery, BLDG. 110
Maywood, IL 60153-3328
Phone (708) 327-3430

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cgodellas34602@direct.luhs.org Other

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090708000411 IL Practitioner - Surgical Oncology 6103977996 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Surgical Oncology
Education
Northwestern University Feinberg Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bonaventure Medical Foundation LLCGroup PAC ID 7517863178, 164 clinicians

Practice addresses (Care Compare)

1786 Moon Lake Blvd
Hoffman Est, IL 60194-5029
Phone (847) 755-8208

800 Biesterfield Rd
Elk Grove Village, IL 60007-3361

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy37
Melanoma (skin cancer) excision24
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036093866ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bonaventure Medical Foundation, LLC CurrentSince Aug 1, 2022 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1786 Moon Lake Blvd
Hoffman Estates, IL 60169
Phone (847) 640-5640

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2160 S 1st Ave
#110
Maywood, IL 60153
Phone (708) 327-3436

2160 S 1st Ave
Bldg 110
Maywood, IL 60153
Phone (708) 327-2626

Interoperability endpoints

  • Direct secure messaging: constantine.godellas.1@380.direct.athenahealth.com

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 5

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": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1740251222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "DEPARTMENT OF SURGERY, BLDG. 110",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-327-3430",
            "fax_number": "708-327-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "DEPARTMENT OF SURGERY, BLDG. 110",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-327-3430",
            "fax_number": "708-327-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODELLAS",
        "first_name": "CONSTANTINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "IL",
            "license": "036093866",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036093866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgodellas34602@direct.luhs.org",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2160 S 1st Ave",
            "address_2": "Department of Surgery, Bldg. 110",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.