Komi Venunye Gayakpa, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

1060 W Perimeter Rd
JB Andrews, MD 20762-6602

Phone

(651) 354-8825

NPI assigned

Jul 27, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1013526995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207626602",
            "telephone_number": "651-354-8825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYAKPA",
        "first_name": "KOMI",
        "middle_name": "VENUNYE",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-27",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT DUTY CORPSMAN",
            "identifier": "IDC",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT DUTY CORPSMAN",
            "identifier": "6513548825",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Louise Florkiewicz, IDMT
• Amanda Atitya Fox, NP-C
• Mathilde French-Elliott
• Annemarie C Galasso, MD
• Danielle E Galt, DPT
• Alisa A Genualdi, AU.D.
• Arlene Elizabeth George
• David Kent Gordon II, M.D.
• Evan Marshall Gregg, MD
• Russell Griffin

• Independent Duty Corpsman in JB Andrews, MD
• Providers in JB Andrews, MD by specialty
• Independent Duty Corpsman in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.