Paul Raymond Gooris, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

84-PA005 Issued in NM

Practice address

110 Sheep Springs Way
Jemez Pueblo, NM 87114

Phone

(505) 834-7413

Fax

(505) 834-7517

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Pueblo of Jemez

  • Clinic/Center
  • Jemez Pueblo, NM
  • NPI 1417082215

  TX

  Medicare reassignment NPD
• Pueblo of Jemez

  • Clinic/Center
  • Jemez Pueblo, NM
  • NPI 1225346547
  NPD

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013008150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 COORS BYP NW",
            "address_2": "APT #1118",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144024",
            "telephone_number": "505-834-7413",
            "fax_number": "505-834-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SHEEP SPRINGS WAY",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "87114",
            "telephone_number": "505-834-7413",
            "fax_number": "505-834-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOORIS",
        "first_name": "PAUL",
        "middle_name": "RAYMOND",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "84-PA005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91314",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Gachupin
• Deyvonna Allison Gachupin, CPHT
• Lena Corrine Gachupin, LISW
• Stuart Gachupin, CPSW
• Alysha Aileen Gallegos-Yepa
• Robert A Gracey, OD
• Megan Patricia Greteman, PA-C
• Nancy Maybeth Harvey, RN, BSN, MPH
• Michael Hennelly, MD
• Shari Jean Hiatt, PA

• Physician Assistant in Jemez Pueblo, NM
• Providers in Jemez Pueblo, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.