Jon Douglas Gambill, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00791 Issued in OR

Practice address

115 S Pine St
Canyonville, OR 97417-9648

Phone

(541) 839-4211

Fax

(541) 839-4983

NPI assigned

Feb 8, 2006

Last updated

Jan 20, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr Anna LLCGroup PAC ID 1254552839, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Roseburg, OR, CCN 387311
• Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DJFADD/Endpoint/DJFADD

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.

• Dr Anna LLC

  dba Canyonville Health and Urgent Care

  • Internal Medicine Physician
  • Canyonville, OR
  • NPI 1003210600
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Oregon, L.L.C.

  dba Amedisys Home Health Care

  • Home Health Agency
  • Roseburg, OR
  • NPI 1093908725
  Care Compare affiliation
• Commonspirit Oregon

  dba CHI Mercy Medical Center

  • General Acute Care Hospital
  • Roseburg, OR
  • NPI 1477590198
  Care Compare affiliation

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1073586319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888",
            "address_2": "115 S PINE STREET",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974170888",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S PINE ST",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974179648",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBILL",
        "first_name": "JON",
        "middle_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donato and Wood Consulting, Inc (Riverside Physical Therapy)
• Dr Anna LLC (Canyonville Health and Urgent Care)
• Falk Family Medicine, LLC
• Gregory Alan Falk, D.O.
• Forest Glen
• Gordons Pharmacy & Gifts LLC (Gordon's Pharmacy and Gifts)
• Nicole April Johnston, DEM
• Reanna Marie Meisner
• Michelle Lynn Reisig, PT
• Valerie Lee Reneau, LMT

• Medical Physician Assistant in Canyonville, OR
• Providers in Canyonville, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.