NPIMap

Individual provider Active NPI

Pamela Jean Gougler, M.D.

  • Family Medicine Physician
  • Lago Vista, TX
National Provider Identifier
1053757104
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R0580 Issued in TX
Practice address
312 Venture Blvd S
Lago Vista, TX 78645-8525
Phone
(512) 466-0472
Fax
(512) 466-0472
NPI assigned
May 16, 2013
Last updated
Jun 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R0580 TX Primary

Addresses

Primary practice location

312 Venture Blvd S
Lago Vista, TX 78645-8525

Mailing address

PO Box 4022
Lago Vista, TX 78645-0010
Phone (512) 466-0472

Other practice location 1

7708 Lohmans Ford Rd Ste 101E
Lago Vista, TX 78645-4783
Phone (512) 466-0472

Other identifiers 1

IdentifierTypeStateIssuer
R0580OtherTXTEXAS LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170124001718 TX Practitioner - Family PracticePractitioner - Emergency MedicinePractitioner - Obstetrics/Gynecology 0749570828 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine, Obstetrics/Gynecology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pecos County Memorial Hospital DistrictGroup PAC ID 3173977477, shared by 7 NPIs, 32 clinicians

Practice addresses (Care Compare)

308 Hudspeth St
Sonora, TX 76950-8003
Phone (325) 387-2521

387 W Ih
Suite 10
Fort Stockton, TX 79735
Phone (432) 336-2058

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0580TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pecos County Memorial Hospital Family Medicine Current Accepting new patients
Pecos County Memorial Hospital CurrentSince Apr 1, 2019 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Dec 15, 2018 Accepting new patients
Sutton County Hospital District CurrentSince Jan 1, 2026 Accepting new patients
Ballinger Memorial Hospital District Current Accepting new patients
Sutton County Hospital District CurrentSince Jan 1, 2026 Accepting new patients

Locations

608 Avenue B
Ballinger, TX 76821
Phone (325) 365-2531

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

1100 E Loop 304
Crockett, TX 75835
Phone (936) 546-3862

511 N Main St
Fort Stockton, TX 79735
Phone (432) 336-2291

387 W Interstate 10
Fort Stockton, TX 79735
Phone (432) 336-2004

1110 N Sarah Dewitt Dr
Gonzales, TX 78629
Phone (830) 672-3845

308 Hudspeth St
Sonora, TX 76950
Phone (325) 387-2521

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/pecos-a6289fb5

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1368662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1053757104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4022",
            "city": "LAGO VISTA",
            "state": "TX",
            "postal_code": "786450010",
            "telephone_number": "512-466-0472",
            "fax_number": "512-466-0472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 VENTURE BLVD S",
            "city": "LAGO VISTA",
            "state": "TX",
            "postal_code": "786458525",
            "telephone_number": "512-466-0472",
            "fax_number": "512-466-0472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7708 Lohmans Ford Rd Ste 101E",
            "address_purpose": "LOCATION",
            "city": "Lago Vista",
            "state": "TX",
            "postal_code": "786454783",
            "country_code": "US",
            "telephone_number": "512-466-0472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOUGLER",
        "first_name": "PAMELA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-16",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R0580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS LICENSE NUMBER",
            "identifier": "R0580",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lago Vista, TX

Sources for this page

Verify at the official NPI Registry.