NPIMap

Organization Active NPI

Evocare Wound Solutions PA

  • Geriatric Medicine (Family Medicine) Physician
  • Chicago, IL
National Provider Identifier
1922827872
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
EVOCARE WOUND SOLUTIONS PA
Practice address
400 N May St Ste 101
Chicago, IL 60642-6495
Phone
(800) 766-0666
Fax
(800) 297-0666
NPI assigned
Oct 8, 2024
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Dominic Gaziano, MDNPI 1275699209
Title
Owner
Phone
(800) 766-0666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

400 N May St Ste 101
Chicago, IL 60642-6495

Mailing address

400 N May St Ste 101
Chicago, IL 60642-6495
Phone (800) 766-0666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL, IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20241223001756 FL Part B Supplier - Clinic/Group Practice 5597292011 Receives reassigned benefits from 2 practitioners
Practice locations: Sarasota, FL
O20250123001782 IL Part B Supplier - Clinic/Group Practice 5597292011 Receives reassigned benefits from 19 practitioners
Practice locations: Chicago, IL
O20250521003010 IN Part B Supplier - Clinic/Group Practice 5597292011 Receives reassigned benefits from 4 practitioners
Practice locations: Greenwood, IN

National Provider Directory

National Provider Directory

Locations

7632 15th St E
Sarasota, FL 34243
Phone (312) 498-6616

400 N May St
Ste 101
Chicago, IL 60642
Phone (312) 498-6616

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1922827872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N MAY ST STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606426495",
            "telephone_number": "800-766-0666",
            "fax_number": "800-297-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MAY ST STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606426495",
            "telephone_number": "800-766-0666",
            "fax_number": "800-297-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOCARE WOUND SOLUTIONS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "GAZIANO",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-766-0666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.