BART WAYNE GASTWIRTH (NPI# 1568459030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1568459030 |
Entity Type | Individual |
Full Name | BART WAYNE GASTWIRTH |
Credential | D.P.M. |
Practice Address |
1802 S Mattis Ave Champaign IL 61821-5923 |
Mailing Address |
611 W Park St Bwpc Urbana IL 61801-2529 |
Practice Telephone | 2173833260 |
Practice Fax Number | 2173834459 |
Mailing Telephone | 2173836941 |
Enumeration Date | 2005-09-30 |
Last Update Date | 2016-10-18 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 213E00000X | Podiatrist | 016-0002956 | IL | Podiatric Medicine & Surgery Service Providers |
N | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
016-002956 | IL | Podiatric Medicine & Surgery Service Providers |
N | 213ER0200X |
Podiatrist Specialization: Radiology |
016-002956 | IL | Podiatric Medicine & Surgery Service Providers |
N | 213ES0000X |
Podiatrist Specialization: Sports Medicine |
016-0002956 | IL | Podiatric Medicine & Surgery Service Providers |
Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
016-002956 | IL | Podiatric Medicine & Surgery Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | BLUE CROSS BLUE SHIELD | 60001121 | 01 |
Street Address |
1802 S MATTIS AVE |
City | CHAMPAIGN |
State | IL |
Zip Code | 61821-5923 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982230124 | Bradley Thompson | Registered Nurse | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-03-19 |
1710510136 | Jeanie Mickelsen | Social Worker | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-02-13 |
1003456369 | Rachael D Rubin | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-01-14 |
1114563640 | Mary K Kiesewetter | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-11-19 |
1083255343 | Lisa A. Ellingwood | Registered Nurse | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-10-07 |
1841843539 | Rakisha Wilks | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-07-22 |
1558869081 | Kristin E Thies | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2018-01-30 |
1215463971 | Mercy E Eigbike | Psychiatry & Neurology | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2017-05-02 |
1770034878 | Tammie Roedl | Social Worker | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2016-10-24 |
1881080372 | Deanna Kane | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2015-04-10 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326532888 | Cunningham Children's Home of Urbana Il | Residential Treatment Facility, Emotionally Disturbed Children | 1303 N. Cunningham Avenue, Urbana, IL 61821 | 2018-06-19 |
1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
1457698169 | Mohamad Ata | Registered Nurse | 1802 S. Mattis, Champaign, IL 61821 | 2013-01-15 |
1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
1679850887 | Kirk Donald Gohsman | Counselor | 106 S. Country Fair Drive, Suite C, Champaign, IL 61821 | 2011-11-16 |
1598054777 | Delbert William Nelson Jr. | Psychiatry & Neurology | 2115 Galen Dr, Champaign, IL 61821 | 2011-03-28 |
1790946929 | Rdi Vein LLC | Clinic/Center | 2502 Galen Drive, Suite 101, Champaign, IL 61821 | 2008-06-20 |
1366620064 | Advanced Aesthetics Surgery & Laser Center, P.C. | Clinic/Center | 2111 West Park Ct., Champaign, IL 61821 | 2008-02-05 |
1033398482 | Huey's Home Medical, Inc | Durable Medical Equipment & Medical Supplies | 1207 S Mattis Ave Ste 1, Champaign, IL 61821 | 2007-11-01 |
1265630537 | Elizabeth Catherine Tingley | Psychologist | Department of Psychiatry and Psychology-carle Physician, 1802 S. Mattis, Champaign, IL 61821 | 2007-07-06 |
Find all providers in zip 61821 |
Taxonomy Code | 213ES0131X |
Grouping | Podiatric Medicine & Surgery Service Providers |
Classification | Podiatrist |
Specialization | Foot Surgery |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902269301 | Jillian Cabai | Podiatrist | 3000 N Halsted St Ste 606, Chicago, IL 60657-6456 | 2016-04-01 |
1710279641 | Prpodiatry, LLC | Podiatrist | 433 W Briar Pl, Unit 7b, Chicago, IL 60657-4752 | 2011-05-11 |
1205071149 | Bradley W. Buckrop Dpm | Podiatrist | 3727 46th Ave, Suite 103, Rock Island, IL 61201-7078 | 2008-12-05 |
1396919130 | Marwa Sayed | Podiatrist | 7255 W 87th St Unit 1, Bridgeview, IL 60455-1821 | 2008-04-14 |
1013191287 | Nikola Ivancevic Dpm PC | Podiatrist | 135 S Palmer Dr, Suite 105, Elmhurst, IL 60126-3403 | 2007-12-24 |
1659577575 | Pam Eernisse Dpm Sc | Podiatrist | 680 N Lake Shore Dr # 1305, Chicago, IL 60611-4546 | 2007-06-26 |
1720118367 | Larry Allen Keyes | Podiatrist | 1023 Madison St, Oak Park, IL 60302-4404 | 2007-03-06 |
1548399462 | Two Steps Ahead Podiatry, Inc. | Podiatrist | 1001 E Wilson St Ste 180, Batavia, IL 60510-3168 | 2007-03-05 |
1447392972 | Willie Lee Brown | Podiatrist | 10700 Lincoln Trl, Suite E, Fairview Heights, IL 62208-2037 | 2007-02-12 |
1972685410 | Nikola Ivancevic | Podiatrist | 5646 St Charles Rd, Suite B, Berkeley, IL 60163 | 2006-10-20 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.