Individual provider Active NPI

Ralph E Gauen, M.D.

  • Internal Medicine Physician
  • Springfield, IL
National Provider Identifier
1942219324
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036052267 Issued in IL
Practice address
2901 Old Jacksonville Rd
Springfield, IL 62704-7437
Phone
(217) 698-6722
Fax
(217) 391-0392
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036052267 IL Primary

Addresses

Primary practice location

2901 Old Jacksonville Rd
Springfield, IL 62704-7437

Mailing address

PO Box 500
Chatham, IL 62629-0500
Phone (217) 670-2424

Other identifiers 1

IdentifierTypeStateIssuer
036052267MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036052267ILMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401235200000",
    "number": "1942219324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "CHATHAM",
            "state": "IL",
            "postal_code": "626290500",
            "telephone_number": "217-670-2424",
            "fax_number": "217-670-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-6722",
            "fax_number": "217-391-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUEN",
        "first_name": "RALPH",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2014-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036052267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052267",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.