Active NPI
Brandon Charles Gimbel, M.D.
- Psychiatry Physician
- Northbrook, IL
National Provider Identifier
1992976591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036131722
- Practice address
- 333 Skokie Blvd
Suite 114
Northbrook, IL 60062-1613 - Phone
- (847) 721-9665
- Fax
- (888) 246-6973
- NPI assigned
- Mar 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 236631 | MA | |
| Psychiatry Physician | 2084P0800X | 036131722 | IL | Primary |
Addresses
Primary practice location
333 Skokie Blvd
Suite 114
Northbrook, IL 60062-1613
Mailing address
333 Skokie Blvd
Suite 114
Northbrook, IL 60062-1613
Phone (847) 721-9665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2015 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036131722 | IL | MD | Psychiatry Physician |
| 236631 | MA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mount Auburn Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatric Hospital Unit
- Cambridge, MA
- NPI 1649254491
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420675200000",
"number": "1992976591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 SKOKIE BLVD",
"address_2": "SUITE 114",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621613",
"telephone_number": "847-721-9665",
"fax_number": "888-246-6973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 SKOKIE BLVD",
"address_2": "SUITE 114",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621613",
"telephone_number": "847-721-9665",
"fax_number": "888-246-6973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIMBEL",
"first_name": "BRANDON",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-21",
"last_updated": "2015-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "236631",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036131722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.