Individual provider Active NPI

Brandi Dalton Gomez, NP

  • Family Nurse Practitioner
  • Gloucester, VA
National Provider Identifier
1043864564
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024183127 Issued in VA
Practice address
5659 Parkway Dr Ste 210
Gloucester, VA 23061-3792
Phone
(804) 210-1025
Fax
(804) 210-1029
NPI assigned
Aug 1, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95011843 CA
Family Nurse Practitioner 363LF0000X 0024183127 VA Primary

Addresses

Primary practice location

5659 Parkway Dr Ste 210
Gloucester, VA 23061-3792

Mailing address

5659 Parkway Dr Ste 210
Gloucester, VA 23061-3792
Phone (804) 210-1025

Other practice location 1

51 Wellness Way
Valley Springs, CA 95252
Phone (209) 754-4468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20211217000233 VA Practitioner - Nurse Practitioner 2567888688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

5659 Pkwy Dr
Suite 210
Gloucester, VA 23061-3792
Phone (804) 210-1025

Hospital & facility affiliations

  • Sentara Williamsburg Regional Medical Center Hospital, Williamsburg, VA, CCN 490066
  • Riverside Walter Reed Hospital Hospital, Gloucester, VA, CCN 490130
  • Sentara Careplex Hospital Hospital, Hampton, VA, CCN 490093

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024183127VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group CurrentSince Jan 31, 2022 Accepting new patients
Mark Twain Medical Center PastSince Aug 1, 2019 Accepting new patients

Locations

5659 Parkway Dr
Ste 210
Gloucester, VA 23061
Phone (804) 210-1025

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1043864564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5659 PARKWAY DR STE 210",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230613792",
            "telephone_number": "804-210-1025",
            "fax_number": "804-210-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5659 PARKWAY DR STE 210",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230613792",
            "telephone_number": "804-210-1025",
            "fax_number": "804-210-1029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Wellness Way",
            "address_purpose": "LOCATION",
            "city": "Valley Springs",
            "state": "CA",
            "postal_code": "95252",
            "country_code": "US",
            "telephone_number": "209-754-4468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "BRANDI",
        "middle_name": "DALTON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-01",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95011843",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024183127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester, VA

Sources for this page

Verify at the official NPI Registry.