Individual provider Active NPI

Michael Gore, PA

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1003823378
Registry record updated May 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008532-1 Issued in NY
Practice address
2818 Ocean Ave
Suite #1
Brooklyn, NY 11235-3170
Phone
(718) 934-8484
NPI assigned
Aug 1, 2006
Last updated
May 12, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 008532-1 NY Primary

Addresses

Primary practice location

2818 Ocean Ave
Suite #1
Brooklyn, NY 11235-3170

Mailing address

482 Tennyson Dr
Staten Island, NY 10312-6552
Phone (718) 360-8607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20040303000279 NY Practitioner - Physician Assistant 6901793090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
008532-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC Physician Assistant CurrentSince Dec 30, 2022 Accepting new patients
True North Medical Group PC CurrentSince Dec 30, 2022 Accepting new patients

Locations

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

Interoperability endpoints

  • Direct secure messaging: michaelgore@nslijmedgr.allscriptsdirect.net

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242086400000",
    "number": "1003823378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 TENNYSON DR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103126552",
            "telephone_number": "718-360-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2818 OCEAN AVE",
            "address_2": "SUITE #1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353170",
            "telephone_number": "718-934-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2009-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008532-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.