Individual provider Active NPI

Benjamin Eoin Gutierrez, MD

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1811525504
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036168372 Issued in IL
Practice address
7435 W Talcott Ave
Chicago, IL 60631-3707
Phone
(301) 920-6556
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01092441A IN
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 036168372 IL Primary

Addresses

Primary practice location

7435 W Talcott Ave
Chicago, IL 60631-3707

Mailing address

7435 W Talcott Ave
Chicago, IL 60631-3707

Other practice location 1

22 S Greene St Rm N3E09
Baltimore, MD 21201-1544
Phone (301) 920-6556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240221001552 IL Practitioner - Emergency Medicine 3476963968 Reassigns benefits to 1 organization
I20240814001420 IN Practitioner - Emergency Medicine 3476963968 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Aug 5, 2024 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Aug 1, 2024 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Aug 1, 2024 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Aug 5, 2024 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

7435 W Talcott Ave
Chicago, IL 60631
Phone (773) 467-9977

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

8451 S Emerson Ave
Indianapolis, IN 46237
Phone (317) 884-7540

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1811525504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707",
            "telephone_number": "301-920-6556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 S Greene St Rm N3E09",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011544",
            "country_code": "US",
            "telephone_number": "301-920-6556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "BENJAMIN",
        "middle_name": "EOIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01092441A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036168372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.