Active NPI
Gomgom Siregar
- Home Health Aide
- Centennial, CO
National Provider Identifier
1043664907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 5235 S Liverpool Way
Centennial, CO 80015 - Phone
- (720) 998-6372
- NPI assigned
- Apr 18, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
5235 S Liverpool Way
Centennial, CO 80015
Mailing address
5235 S Liverpool Way
Centennial, CO 80015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87637065 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gabriel Assisted Living | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Assisted Living Facility
- Centennial, CO
- NPI 1376098608
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460937600000",
"number": "1043664907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5235 S LIVERPOOL WAY",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "80015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5235 S LIVERPOOL WAY",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "80015",
"telephone_number": "720-998-6372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIREGAR",
"first_name": "GOMGOM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-18",
"last_updated": "2016-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "87637065",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centennial, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.