MEDICARE: DR. GREGORY BARNETT M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	036091297	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8415040	OTHER	IL	BLUE CROSS NUMBER
2	L031806	OTHER	IL	CHAMPUS/TRICARE
3	104409	OTHER	IL	HEALTHLINK GROUP NUMBER
4	085972	OTHER	IL	HEALTH ALLIANCE NUMBER
5	273639	OTHER	IL	HEALTHLINK UPIN NUMBER
6	32490	OTHER	IL	PERSONAL CARE

NPI Number	:	1669460846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY BARNETT M.D.

Provider Business Mailing Address
First Line	:	800 EAST CARPENTER STREET
Second Line	:	ROOM 2K64
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-0001
Country	:	US
Telephone Number	:	217-525-5643
Fax Number	:	217-544-2521

Provider Business Practice Location Address
First Line	:	800 EAST CARPENTER STREET
Second Line	:	ROOM 2K64
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-0001
Country	:	US
Telephone Number	:	217-525-5643
Fax Number	:	217-544-2521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	12/29/2021

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

800 EAST CARPENTER ST , ROOM 2K64
SPRINGFIELD, IL
62769-0001