Nicole Michele Gastala, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.145379 Issued in IL

Practice address

1220 S Wood St
Chicago, IL 60608

Phone

(708) 642-6875

NPI assigned

Jun 19, 2012

Last updated

Nov 22, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Family PracticeAlso: Emergency Medicine

Education

Loyola University of Chicago, Stritch School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, shared by 24 NPIs, 1,134 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Illinois Hospital and Clinics Hospital, Chicago, IL, CCN 140150

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ngastala17057@uihealth.direct-ci.com

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.

• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  dba Uih-Mile Square Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1669493466
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  dba Occupational Health Service Institute (OHSI)

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD
• The Board of Trustees of the University of Illinois

  dba UI Health Mile Square Health Center L. P. Johnson Rockford

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1306486022
  NPD
• The Board of Trustees of the University of Illinois

  dba National Teachers Academy Clinic

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1356367304
  NPD
• The Board of Trustees of the University of Illinois

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1215156344
  NPD (past)

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

• The Board of Trustees of the University of Illinois

  dba University of Illinois Hospital and Clinics

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1861431751
  Care Compare affiliation

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542844800000",
    "number": "1912260571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S PRAIRIE AVE UNIT 1311",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053157",
            "telephone_number": "708-642-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 S WOOD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60608",
            "telephone_number": "708-642-6875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "412 E Church St",
            "address_purpose": "LOCATION",
            "city": "Marshalltown",
            "state": "IA",
            "postal_code": "501582947",
            "country_code": "US",
            "telephone_number": "641-753-4021",
            "fax_number": "641-753-4025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GASTALA",
        "first_name": "NICOLE",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2018-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IA",
            "license": "R 9515",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "41628",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.145379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Gassett, DPT
• Garrett David Gast, DDS
• Sarah J Gast
• Scott Gast
• Margeaux Ardiente Gastala, FNP-BC
• Dragan Gastevski, MD
• Darrien Lance Gaston, M.D.
• Gina Blanche Gaston, MSW, PHD, LCSW
• Ian Gaston
• Jocelyn Gaston

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2018; 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.