NPIMap

Organization Active NPI

Gateway Professional Services, PC

  • Addiction (Substance Use Disorder) Counselor
  • Carbondale, IL
National Provider Identifier
1982242368
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
GATEWAY PROFESSIONAL SERVICES, PC
Practice address
1080 E Park St
Carbondale, IL 62901-3812
Phone
(877) 381-6538
NPI assigned
Dec 16, 2019
Organization subpart
Yes
Parent organization
GATEWAY PROFESSIONAL SERVICES, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Authorized official

Name
Dr. Roueen Rafeyan
Title
President
Phone
(312) 663-1130

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

1080 E Park St
Carbondale, IL 62901-3812

Mailing address

55 E Jackson Blvd Ste 1500
Chicago, IL 60604-4184
Phone (312) 663-1130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210512002910 IL Part B Supplier - Clinic/Group Practice 2961811401 Receives reassigned benefits from 5 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Swansea, IL; Springfield, IL; Skokie, IL; Peoria, IL; Lake Villa, IL; Joliet, IL; Jacksonville, IL; Downers Grove, IL…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Gateway Professional Services PC17 organizations share this tax ID, including this one
Part of
Gateway Professional Services PC

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1982242368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E JACKSON BLVD STE 1500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044184",
            "telephone_number": "312-663-1130",
            "fax_number": "312-663-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 E PARK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013812",
            "telephone_number": "877-381-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY PROFESSIONAL SERVICES, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GATEWAY PROFESSIONAL SERVICES, PC",
        "enumeration_date": "2019-12-16",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "RAFEYAN",
        "authorized_official_first_name": "ROUEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-663-1130",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.