Eshwar Gumidyala, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036-094022 Issued in IL

Practice address

500 Coventry LN
Suite 205
Crystal Lake, IL 60014-7579

Phone

(815) 455-7100

Fax

(815) 455-3951

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Psychiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Horizons Behavioral Health LLCGroup PAC ID 4385531672, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Horizons Behavioral Health LLC

  • Social Worker
  • Crystal Lake, IL
  • NPI 1881692689
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341446400000",
    "number": "1891794137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COVENTRY LN",
            "address_2": "SUITE 205",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147579",
            "telephone_number": "815-455-7100",
            "fax_number": "815-455-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COVENTRY LN",
            "address_2": "SUITE 205",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147579",
            "telephone_number": "815-455-7100",
            "fax_number": "815-455-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUMIDYALA",
        "first_name": "ESHWAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2012-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-094022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036094022",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Grudzien
• Gary G Gruebnau, LSW MASTERS
• Grace Page Grzybek
• Linda Hnetynka Gullo, LCPC
• Edwin Vera Gumapas, MD
• Gupta Medical Clinic LTD
• Sanjeev Gupta, MD
• Rachel Lee Gussman
• Abigail Guthrie
• Jamie L Gutierrez

• Psychiatry Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.