NPIMap

Individual provider Active NPI

Guy R Abderholden, MD

  • Family Medicine Physician
  • Antioch, IL
National Provider Identifier
1902899792
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-084853 Issued in IL
Practice address
543 Orchard St
Antioch, IL 60002-3107
Phone
(847) 395-3322
Fax
(847) 395-0921
NPI assigned
Aug 26, 2005
Last updated
Dec 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33453020 WI
Family Medicine Physician 207Q00000X 036-084853 IL Primary

Addresses

Primary practice location

543 Orchard St
Antioch, IL 60002-3107

Mailing address

543 Orchard St
Antioch, IL 60002-3107
Phone (847) 395-3322

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address guyabderholden@orchardmed.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100213000020 IL Practitioner - Family PracticePractitioner - General Practice 7012942592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orchard Medical Center SCGroup PAC ID 9133154610, 4 clinicians

Practice addresses (Care Compare)

543 Orchard St
Antioch, IL 60002-3107
Phone 8473953322111

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-084853ILMDFamily Medicine Physician
33453020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orchard Medical Center SC Family Medicine CurrentSince Jul 3, 1992 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: guyabderholden@orchardmed.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1902899792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "543 ORCHARD ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600023107",
            "telephone_number": "847-395-3322",
            "fax_number": "847-395-0921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 ORCHARD ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600023107",
            "telephone_number": "847-395-3322",
            "fax_number": "847-395-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDERHOLDEN",
        "first_name": "GUY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "33453020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-084853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "guyabderholden@orchardmed.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "543 Orchard St",
            "city": "Antioch",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600023107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Antioch, IL

Sources for this page

Verify at the official NPI Registry.