Individual provider Active NPI

Rhonda Jo Gola, FNP

  • Family Nurse Practitioner
  • South Haven, MI
National Provider Identifier
1003555368
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704383606 Issued in MI
Practice address
930 Blue Star Hwy
South Haven, MI 49090-7758
Phone
(269) 637-1115
NPI assigned
Jun 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704383606 MI Primary

Addresses

Primary practice location

930 Blue Star Hwy
South Haven, MI 49090-7758

Mailing address

601 John Street
Box 39
Kalamazoo, MI 49007-9438

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220718001368 MI Practitioner - Nurse Practitioner 5698156941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians
Bronson Lakeview HospitalGroup PAC ID 9032008495, 72 clinicians

Practice addresses (Care Compare)

3951 W Milham Ave
Portage, MI 49024-1088
Phone (269) 447-1689

930 Blue Star Hwy
South Haven, MI 49090-7758
Phone (269) 637-1115

Hospital & facility affiliations

  • Bronson South Haven Hospital Hospital, South Haven, MI, CCN 230085
  • Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332
  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704383606MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Lakeview Hospital CurrentSince Aug 1, 2022 Accepting new patients
Bronson Lakeview Hospital CurrentSince Aug 1, 2022 Accepting new patients
Bronson Methodist Hospital PastSince Jul 31, 2022 Accepting new patients

Locations

601 John St
#39
Kalamazoo, MI 49007

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

930 Blue Star Hwy
South Haven, MI 49090
Phone (269) 637-1115

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1003555368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN STREET",
            "address_2": "BOX 39",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490079438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 BLUE STAR HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907758",
            "telephone_number": "269-637-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLA",
        "first_name": "RHONDA",
        "middle_name": "JO",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704383606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Haven, MI

Sources for this page

Verify at the official NPI Registry.