1. Home
  2. Directory
  3. Illinois
  4. Willowbrook
  5. Family Medicine
  6. NPI Profile

SAGUN GAUTAM MD
NPI 1205049046
Family Medicine in Willowbrook, IL

Active since May 08, 2007PECOS EnrolledAccepts Medicare Assignment
12.79/100
CMS Quality Rating
534 PLAINFIELD RD, WILLOWBROOK, IL 60527(087) 835-5507 Get Directions Write a Review

NPPES record last updated: October 7, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 7, 2025, Feb 19, 2022 (2 updates tracked since 2022).

About Sagun Gautam Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAGUN GAUTAM MD (NPI 1205049046) is an individual family medicine provider in Willowbrook, Illinois, licensed in Illinois (036-120619) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with West Suburban Medical Center, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1205049046
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameSAGUN GAUTAMCredential: MD
Location Address534 PLAINFIELD RDWillowbrook, IL 60527-5342
Mailing Address534 Plainfield RdWillowbrook, IL 60527-5342 · (708) 783-5550 · Fax (630) 756-4153
Phone(087) 835-5507
Sole ProprietorNo
Medical School CMSOtherGraduated 2010
Enumeration DateMay 8, 2007
Last NPPES UpdateOctober 7, 20252 updates tracked since enumeration
NPPES CertifiedOctober 7, 2025
✔ NPI 1205049046 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IL · 036-120619
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
534 PLAINFIELD RD, Willowbrook, IL 60527
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sagun Gautam Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3476746462
PECOS Enrollment IDI20101022000479
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Sagun Gautam reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Chicagoland Integrated Professionals, Inc
7.7 mi
Family Medicine
1132 MANCHESTER AVE
Westchester, IL 60154
  • Reassigned Medicare billing, Illinois enrollment
  • 4 clinicians in this Medicare group
NPI 1649688409 (219) 934-5300
Community First Healthcare Of Illinois, Inc.
15 mi
Internal Medicine
5645 W ADDISON ST
Chicago, IL 60634
  • Reassigned Medicare billing, Illinois enrollment
  • 174 clinicians in this Medicare group
NPI 1962894675 (773) 794-8320
Transitions Home Medical Group PLLC
17 mi
Nurse Practitioner
2312 TOUHY AVE
Elk Grove Village, IL 60007
  • Reassigned Medicare billing, Illinois enrollment
  • 44 clinicians in this Medicare group
NPI 1871890657 (847) 515-1505

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
2,737 services504 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
561 services476 patients
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
325 services56 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
76 services40 patients
Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306
An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
54 services52 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
37 services30 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

West Suburban Medical Center

Acute Care Hospitals · Oak Park, IL
1/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140049
Location3 Erie CourtOak Park, IL 60302 · Cook County
Birthing friendly

Macneal Hospital

Acute Care Hospitals · Berwyn, IL
2/5 CMS rating
OwnershipProprietary
CMS Certification Number140054
Location3249 South Oak Park AvenueBerwyn, IL 60402 · Cook County
Emergency services Birthing friendly

Adventist La Grange Memorial Hospital

Acute Care Hospitals · La Grange, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140065
Location5101 S Willow Springs RdLa Grange, IL 60525 · Cook County
Emergency services

Adventist Hinsdale Hospital

Acute Care Hospitals · Hinsdale, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140122
Location120 North Oak StHinsdale, IL 60521 · Du Page County
Emergency services Birthing friendly

Community First Medical Center

Acute Care Hospitals · Chicago, IL
1/5 CMS rating
OwnershipProprietary
CMS Certification Number140251
Location5645 W Addison StreetChicago, IL 60634 · Cook County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60527 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$93.02 typical visit price
range $59.81 – $181.38
Typical copayment $23.25 (range $14.95 – $45.34)
Most-billed visit code 99203
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

12.79/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality0
Improvement Activities0
Cost42.65

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
100%33 patients5/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
2 suppliers20 claims20 services$14.64 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
3 suppliers32 claims32 services$61.92 avg. paid by Medicare
Lightweight wheelchair K0003
DME-Wheelchairs · category DD000N
1 supplier15 claims15 services$33.50 avg. paid by Medicare
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738
DME-Oxygen and Supplies · category DC000N
1 supplier12 claims12 services$31.15 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MONA J PATEL
Nurse Practitioner (Family)
534 PLAINFIELD RD
WILLOWBROOK, IL 60527
Dupage County (217) 553-5936
JENNIFER BURAGA NP
Nurse Practitioner (Family)
534 PLAINFIELD RD
WILLOWBROOK, IL 60527
Dupage County (630) 506-3428

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sagun Gautam's NPI number?

The NPI number for Sagun Gautam is 1205049046. It was assigned to this individual provider in the NPPES registry on May 8, 2007.

Where is Sagun Gautam located?

Sagun Gautam practices at 534 Plainfield Rd, Willowbrook, IL 60527. The listed phone number is (087) 835-5507.

What is Sagun Gautam's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sagun Gautam enrolled in Medicare?

Yes. Sagun Gautam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Sagun Gautam's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sagun Gautam reassigns Medicare benefits to 3 organizations: Chicagoland Integrated Professionals, Inc (Westchester, IL), Community First Healthcare Of Illinois, Inc. (Chicago, IL) and Transitions Home Medical Group PLLC (Elk Grove Village, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Sagun Gautam's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sagun Gautam accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Oscar Health list Sagun Gautam as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Sagun Gautam affiliated with any hospitals?

According to CMS data, Sagun Gautam is affiliated with West Suburban Medical Center, Macneal Hospital, Adventist La Grange Memorial Hospital, Adventist Hinsdale Hospital and Community First Medical Center.

When was this NPI record last updated?

The NPPES record for Sagun Gautam was last updated on October 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.