Active NPI
Martin J Gonzalez, OT
- Physical Medicine & Rehabilitation Physician
- Chicago, IL
National Provider Identifier
1750600987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 056002902
- Practice address
- 2525 S Michigan Ave
B-522
Chicago, IL 60616-2333 - Phone
- (312) 567-5550
- Fax
- (312) 567-2079
- NPI assigned
- May 27, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 056002902 | IL | Primary |
Addresses
Primary practice location
2525 S Michigan Ave
B-522
Chicago, IL 60616-2333
Mailing address
2525 S Michigan Ave
B-522
Chicago, IL 60616-2333
Phone (312) 567-5550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01621679 | Other | IL | BCBS |
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 |
|---|---|---|---|
| 056002902 | IL | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274918400000",
"number": "1750600987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 S MICHIGAN AVE",
"address_2": "B-522",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606162333",
"telephone_number": "312-567-5550",
"fax_number": "312-567-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 S MICHIGAN AVE",
"address_2": "B-522",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606162333",
"telephone_number": "312-567-5550",
"fax_number": "312-567-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "MARTIN",
"middle_name": "J",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-27",
"last_updated": "2010-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IL",
"license": "056002902",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01621679",
"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 May 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.