Individual provider Active NPI

Eleni Gorla

  • Student in an Organized Health Care Education/Training Program
  • Tucson, AZ
National Provider Identifier
1043972755
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
222008 Issued in AZ
Practice address
101 W Irvington Rd BLDG 10
Tucson, AZ 85714-3050
Phone
(520) 670-3909
Fax
(520) 309-2560
NPI assigned
Oct 10, 2021
Last updated
Jan 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 222008 AZ Primary

Addresses

Primary practice location

101 W Irvington Rd BLDG 10
Tucson, AZ 85714-3050

Mailing address

839 W Congress St
Tucson, AZ 85745-2819
Phone (520) 670-3909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20221104001101 AZ Practitioner - Nurse Practitioner 7315314358 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Arizona College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

839 W Congress St
Tucson, AZ 85745-2819
Phone (520) 670-3909

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
222008AZMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
El Rio Santa Cruz Neighborhood Health Center, Inc CurrentSince Aug 29, 2022 Accepting new patients
El Rio Santa Cruz Neighborhood Health Center, Inc CurrentSince Aug 29, 2022 Accepting new patients
El Rio Santa Cruz Neighborhood Health Center, Inc Past Accepting new patients

Locations

101 W Irvington Rd
Tucson, AZ 85714
Phone (520) 670-3707

101 W Irvington Rd
Bldg 10
Tucson, AZ 85714
Phone (520) 309-4585

3655 E Grant Rd
Tucson, AZ 85716
Phone (520) 440-6323

839 W Congress St
Tucson, AZ 85745
Phone (520) 670-3707

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1633824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1043972755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 W CONGRESS ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857452819",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W IRVINGTON RD BLDG 10",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857143050",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORLA",
        "first_name": "ELENI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-10",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "222008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.