DR. ALBERT F GILMAN IV M.D.
NPI 1225094436
Surgery in Decatur, IL

Q: What is Albert Gilman's NPI number?

The NPI number for Albert Gilman is 1225094436. It was assigned to this individual provider in the NPPES registry on April 25, 2006.

Q: What is Albert Gilman's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Albert Gilman was last updated on October 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.

Active since April 25, 2006PECOS EnrolledAccepts Medicare Assignment

67.18/100

CMS Quality Rating

1 MEMORIAL DR STE 300, DECATUR, IL 62526(217) 876-5500(217) 876-5505 Get Directions Write a Review

NPPES record last updated: October 20, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Dr. Albert F Gilman Iv M.d. NPPES

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

DR. ALBERT F GILMAN IV M.D. (NPI 1225094436) is an individual surgery provider in Decatur, Illinois, licensed in Illinois (036098200) and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS, is affiliated with Decatur Memorial Hospital, and is a graduate of Wake Forest University School Of Medicine (1993).

NPPES Registry Identity

NPI1225094436

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameDR. ALBERT F GILMAN IVCredential: M.D.

Location Address1 MEMORIAL DR STE 300Decatur, IL 62526-6322

Mailing Address2300 N Edward St, GsbllDecatur, IL 62526-4163 · (217) 876-2857 · Fax (217) 876-2874

Phone(217) 876-5500

Fax(217) 876-5505

Sole ProprietorNo

Medical School CMSWake Forest University School Of MedicineGraduated 1993

Enumeration DateApril 25, 2006

Last NPPES UpdateOctober 20, 2021

NPPES CertifiedOctober 20, 2021

✔ NPI 1225094436 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in IL · 036098200

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

1 MEMORIAL DR STE 300, Decatur, IL 62526

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Accepted Insurance

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

Dr. Albert F Gilman Iv M.d. 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 ID5597710004

PECOS Enrollment IDI20050317000583

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

Medicare enrollment records show Albert Gilman reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Decatur Memorial Hospital

0.1 mi

General Acute Care Hospital

2300 N EDWARD ST, GSBLL
Decatur, IL 62526

Reassigned Medicare billing, Illinois enrollment
166 clinicians in this Medicare group

NPI 1164477725 (217) 876-2868

Pana Community Hospital Association

24 mi

Family Medicine

118 N WALNUT ST
Assumption, IL 62510

Reassigned Medicare billing, Illinois enrollment
Also billed through NPI 1942326970 (Illinois)
98 clinicians in this Medicare group

NPI 1487843959 (217) 226-3133

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 14

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 straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

69 services38 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

51 services51 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.

38 services38 patients

Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

37 services37 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

35 services35 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

24 services19 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

23 services21 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

21 services21 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

19 services19 patients

Removal of gallbladder with x-ray study of bile ducts using an endoscope 47563

This procedure, known as an endoscopic retrograde cholangiopancreatography (ERCP), involves using a flexible camera (endoscope) to examine your bile ducts. If gallstones are found, your gallbladder may be removed in a separate procedure. This helps prevent future complications.

17 services17 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

16 services16 patients

Diagnostic exam of large bowel using a flexible endoscope 45378

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

15 services15 patients

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.

15 services14 patients

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

13 services13 patients

Hospital Affiliations CMS Care Compare 2

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

Decatur Memorial Hospital

Acute Care Hospitals · Decatur, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140135

Location2300 North Edward StreetDecatur, IL 62526 · Macon County

Emergency services Birthing friendly

Pana Community Hospital

Critical Access Hospitals · Pana, IL

OwnershipVoluntary non-profit - Private

CMS Certification Number141341

Location101 E Ninth StreetPana, IL 62557 · Christian County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62526 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

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.

67.18/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

63.86

Improvement Activities

Cost

56.87

Other Providers at the Same Location NPPES 4

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

TIMOTHY S BAILEY M.D.

Surgery

1 MEMORIAL DR STE 300
DECATUR, IL 62526

Macon County (217) 876-5500

MRS. JESSICA MARIE RYDER NP-C

Nurse Practitioner (Family)

1 MEMORIAL DR STE 300
DECATUR, IL 62526

Macon County (217) 428-6300

SAJJAAD SAMAT

Surgery

1 MEMORIAL DR STE 300
DECATUR, IL 62526

Macon County (217) 876-5500

DR. GEORGE ALBERT LIU MD

Surgery

1 MEMORIAL DR STE 300
DECATUR, IL 62526

Macon County (217) 876-5500

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 Albert Gilman's NPI number?

The NPI number for Albert Gilman is 1225094436. It was assigned to this individual provider in the NPPES registry on April 25, 2006.

Where is Albert Gilman located?

Albert Gilman practices at 1 Memorial Dr Ste 300, Decatur, IL 62526. The listed phone number is (217) 876-5500.

What is Albert Gilman's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Albert Gilman enrolled in Medicare?

Yes. Albert Gilman 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 Albert Gilman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Albert Gilman reassigns Medicare benefits to 2 organizations: Decatur Memorial Hospital (Decatur, IL) and Pana Community Hospital Association (Assumption, 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 Albert Gilman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Albert Gilman accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Albert Gilman 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 Albert Gilman affiliated with any hospitals?

According to CMS data, Albert Gilman is affiliated with Decatur Memorial Hospital and Pana Community Hospital.

When was this NPI record last updated?

The NPPES record for Albert Gilman was last updated on October 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.