NPIMap

Individual provider Active NPI

Pavan Kumar K Gona, MD

  • Nephrology Physician
  • Corvallis, OR
National Provider Identifier
1033319199
Registry record updated Aug 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD172330 Issued in OR
Practice address
3615 NW Samaritan Drive
Suite 201
Corvallis, OR 97333
Phone
(541) 768-6930
Fax
(541) 768-6931
NPI assigned
Jul 18, 2007
Last updated
Aug 27, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A100550 CA
Internal Medicine Physician 207R00000X MD172330 OR
Nephrology Physician 207RN0300X MD172330 OR Primary
Hospitalist Physician 208M00000X MD172330 OR

Addresses

Primary practice location

3615 NW Samaritan Drive
Suite 201
Corvallis, OR 97333

Mailing address

3615 NW Samaritan Drive
Suite 201
Corvallis, OR 97333
Phone (541) 768-6930

Other identifiers 2

IdentifierTypeStateIssuer
0A1005500MedicaidCA
A100550OtherCACA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151019002425 OR Practitioner - NephrologyPractitioner - Internal Medicine 3375636137 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Care Physicians LLCGroup PAC ID 0840283511, 11 clinicians

Practice addresses (Care Compare)

875 Oak St SE
Suite 5070
Salem, OR 97301-3998
Phone (503) 511-8565

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A100550CAMDInternal Medicine Physician
MD172330ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany General Hospital Current Accepting new patients
Samaritan Pacific Health Services, Inc Nephrology CurrentSince Sep 15, 2015 Accepting new patients
Samaritan Pacific Health Services, Inc. Current Accepting new patients
Albany General Hospital CurrentSince Sep 15, 2015 Accepting new patients
Kidney Care Physicians LLC Nephrology CurrentSince Oct 1, 2016 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Sep 15, 2015 Accepting new patients
Albany General Hospital CurrentSince Sep 15, 2015 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Sep 15, 2015 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Sep 15, 2015 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Sep 15, 2015 Accepting new patients
Salem Health Past Accepting new patients
Sante Health Foundation Internal Medicine Past Accepting new patients
Community Hospitalist Medical Group Inc. Internal Medicine Past Accepting new patients

Locations

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3615 NW Samaritan Dr
Ste 201
Corvallis, OR 97330
Phone (541) 768-5930

3615 NW Samaritan Dr
Ste 203
Corvallis, OR 97330
Phone (541) 768-6930

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

550 Dietz Ave NE
Keizer, OR 97303
Phone (503) 393-0540

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

875 Oak St SE
Ste 5070
Salem, OR 97301
Phone (503) 561-8564

679 Main St
Sweet Home, OR 97386
Phone (541) 451-6250

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

  • Direct secure messaging: pgona157439@direct.salemhealth.org

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 7

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": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440633600000",
    "number": "1033319199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 NW SAMARITAN DRIVE",
            "address_2": "SUITE 201",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "97333",
            "telephone_number": "541-768-6930",
            "fax_number": "541-768-6931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 NW SAMARITAN DRIVE",
            "address_2": "SUITE 201",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "97333",
            "telephone_number": "541-768-6930",
            "fax_number": "541-768-6931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONA",
        "first_name": "PAVAN KUMAR",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-18",
        "last_updated": "2015-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A100550",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD172330",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OR",
            "license": "MD172330",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD172330",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A1005500",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "A100550",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.