NPIMap

Organization Active NPI

Ganapathi Gottumukkala

  • Family Medicine Physician
  • Tinley Park, IL
National Provider Identifier
1962457614
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-074987 Issued in IL
Legal business name
GANAPATHI GOTTUMUKKALA
Practice address
6701 159TH St
Suite B
Tinley Park, IL 60477-1758
Phone
(708) 614-0893
Fax
(708) 342-1481
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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

Authorized official

Name
Ganapathi Gottumukkala, M.D.NPI 1780683953
Title
Sole Proprietor
Phone
(708) 614-0893

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 036-074987 IL Primary

Addresses

Primary practice location

6701 159TH St
Suite B
Tinley Park, IL 60477-1758

Mailing address

PO Box 849
Matteson, IL 60443-0849
Phone (708) 747-5850

Other identifiers 1

IdentifierTypeStateIssuer
01625532OtherILBCBSIL GROUP #

National Provider Directory

National Provider Directory

Locations

6701 159th St
Ste B
Tinley Park, IL 60477
Phone (708) 614-0893

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1962457614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604430849",
            "telephone_number": "708-747-5850",
            "fax_number": "708-747-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 159TH ST",
            "address_2": "SUITE B",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771758",
            "telephone_number": "708-614-0893",
            "fax_number": "708-342-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GANAPATHI GOTTUMUKKALA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-11-25",
        "status": "A",
        "authorized_official_last_name": "GOTTUMUKKALA",
        "authorized_official_first_name": "GANAPATHI",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "708-614-0893",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-074987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL GROUP #",
            "identifier": "01625532",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; 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.