Individual provider Active NPI

Kathryn Ann Gorsuch, FNP

  • Family Nurse Practitioner
  • Northville, MI
National Provider Identifier
1831605468
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.016814 Issued in IL
Practice address
40474 N Northville TRL
Northville, MI 48168-3244
Phone
(248) 982-1754
NPI assigned
Dec 19, 2017
Last updated
Jun 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.016814 IL Primary

Addresses

Primary practice location

40474 N Northville TRL
Northville, MI 48168-3244

Mailing address

40474 N Northville TRL
Northville, MI 48168-3244
Phone (248) 982-1754

Other practice location 1

2355 S Western Ave
Chicago, IL 60608-3837
Phone (773) 254-1400

Other practice location 2

6447 Cermak Rd
Berwyn, IL 60402-2311
Phone (773) 254-1400

Other practice location 3

966 W 21st St
Chicago, IL 60608-4511
Phone (773) 254-1400

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210825000924 MI Practitioner - Nurse Practitioner 0244635522 Practice locations: Northville, MI

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.016814ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Relish Life Practitioners Inc Past Accepting new patients
Cloud Health Medical Group of California, P.C. Past Accepting new patients
Gabbi Health Medical Group of California, PC Past Accepting new patients
Cloud Health Medical Group, P.a. Past Accepting new patients
Gabbi Health Medical Group, P.a. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kathryn.gorsuch.2@19041.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1831605468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40474 N NORTHVILLE TRL",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481683244",
            "telephone_number": "248-982-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40474 N NORTHVILLE TRL",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481683244",
            "telephone_number": "248-982-1754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2355 S Western Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606083837",
            "country_code": "US",
            "telephone_number": "773-254-1400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6447 Cermak Rd",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604022311",
            "country_code": "US",
            "telephone_number": "773-254-1400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "966 W 21st St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606084511",
            "country_code": "US",
            "telephone_number": "773-254-1400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORSUCH",
        "first_name": "KATHRYN",
        "middle_name": "ANN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.016814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

Verify at the official NPI Registry.