BART WAYNE GASTWIRTH


Address: 1802 S Mattis Ave, Champaign, IL 61821-5923
Phone: 2173833260

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
IL BLUE CROSS BLUE SHIELD 60001121 01

Office Location

Street Address 1802 S MATTIS AVE
City CHAMPAIGN
State IL
Zip Code 61821-5923

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 213ES0131X
Grouping Podiatric Medicine & Surgery Service Providers
Classification Podiatrist
Specialization Foot Surgery

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

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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Competitor

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City CHAMPAIGN
Zip Code 61821

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Dataset Information

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.

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