NPIMap

Organization Active NPI

Gastroenterologists LTD

  • Gastroenterology Physician
  • Libertyville, IL
National Provider Identifier
1891993606
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGISTS LTD
Practice address
1105 W Park Ave Ste 1
Libertyville, IL 60048-2567
Phone
(847) 680-5880
Fax
(847) 680-5881
NPI assigned
Jul 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miss Rashida R
Title
Manager
Phone
(847) 680-5880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X IL Primary

Addresses

Primary practice location

1105 W Park Ave Ste 1
Libertyville, IL 60048-2567

Mailing address

1105 W Park Ave Ste 1
Libertyville, IL 60048-2567
Phone (847) 680-5880

Other identifiers 1

IdentifierTypeStateIssuer
4901136OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312000067 IL Part B Supplier - Clinic/Group Practice 3274422886 Receives reassigned benefits from 12 practitioners
Practice locations: Libertyville, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0937844Gastroenterologists, LTD1105 W Park Ave, Ste 1, Libertyville, IL 60048ComplianceDec 3, 2026

National Provider Directory

National Provider Directory

Locations

363 N Main St
Ste A
Wauconda, IL 60084
Phone (847) 487-0290

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891993606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W PARK AVE STE 1",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482567",
            "telephone_number": "847-680-5880",
            "fax_number": "847-680-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W PARK AVE STE 1",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482567",
            "telephone_number": "847-680-5880",
            "fax_number": "847-680-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGISTS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "R",
        "authorized_official_first_name": "RASHIDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-680-5880",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4901136",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.