Active NPI
Michael Bryan Gonzalez, MD
- Pediatrics Physician
- Rutherford College, NC
National Provider Identifier
1073519450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 200300474
- Practice address
- 111 Hilltop St
Rutherford College, NC 28671-0620 - Phone
- (828) 874-4293
- Fax
- (828) 874-2357
- NPI assigned
- Jun 22, 2005
- Last updated
- Apr 14, 2011
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 200300474 | NC | Primary |
Addresses
Primary practice location
111 Hilltop St
Rutherford College, NC 28671-0620
Mailing address
100 Medical Heights Dr
Morganton, NC 28655-5197
Phone (828) 433-4484
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12 01558 | Other | NC | UNITED HEALTHCARE |
| 89134RN | Medicaid | NC | |
| C8954 | Other | NC | MEDCOST |
| 134RN | Other | NC | BCBS OF NC |
| 4455597 | Other | NC | AETNA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200300474 | NC | MD | Pediatrics Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/956/brand/1/csg/1/fhir/r4
- michael.gonzalez.1@956.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302739200000",
"number": "1073519450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MEDICAL HEIGHTS DR",
"city": "MORGANTON",
"state": "NC",
"postal_code": "286555197",
"telephone_number": "828-433-4484",
"fax_number": "828-433-4487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 HILLTOP ST",
"city": "RUTHERFORD COLLEGE",
"state": "NC",
"postal_code": "286710620",
"telephone_number": "828-874-4293",
"fax_number": "828-874-2357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "MICHAEL",
"middle_name": "BRYAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-22",
"last_updated": "2011-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "200300474",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "12 01558",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89134RN",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "C8954",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "134RN",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4455597",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rutherford College, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.