Individual provider Active NPI

Destinee Soubannarath Gwee

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1932787389
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036.173686 Issued in IL
Practice address
525 E 68TH St
New York, NY 10065-4870
Phone
(212) 746-5454
NPI assigned
Mar 29, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036.173686 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

525 E 68TH St
New York, NY 10065-4870

Mailing address

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-5454

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260107003506 IL Practitioner - Emergency Medicine 7315423514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Practice addresses (Care Compare)

333 Madison St
Joliet, IL 60435-8200
Phone (815) 725-7133

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
036.173686ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 1, 2025 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 1, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

333 Madison St
Joliet, IL 60435
Phone (815) 725-7222

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1932787389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUBANNARATH GWEE",
        "first_name": "DESTINEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.173686",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.