Individual provider Active NPI

Gaurav Gandhi, MD

  • Internal Medicine Physician
  • Longview, WA
National Provider Identifier
1093005084
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60834259 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 501-3601
Fax
(360) 414-5768
NPI assigned
Apr 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60834259 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

1615 Delaware St
PO Box 3002
Longview, WA 98632-0302
Phone (201) 500-8553

Other practice location 1

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (201) 390-8553

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ggandhi1205659@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191010001445 WA Practitioner - Internal Medicine 2769602432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians

Practice addresses (Care Compare)

2211 NE 139TH St
Vancouver, WA 98686-2742
Phone 3604871000360487

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.83 of 100Reported as group
Quality
96.26
Promoting interoperability
100
Improvement activities
40
Cost
79.84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60834259WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Salmon Creek Hospital CurrentSince Nov 1, 2021 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Nov 1, 2021 Accepting new patients

Locations

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Interoperability endpoints

  • Direct secure messaging: ggandhi1205659@oc.providencedirect.org

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 2

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": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1093005084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "address_2": "PO BOX 3002",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986320302",
            "telephone_number": "201-500-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-501-3601",
            "fax_number": "360-414-5768"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 Montgomery Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "95405",
            "country_code": "US",
            "telephone_number": "201-390-8553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANDHI",
        "first_name": "GAURAV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-12",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60834259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ggandhi1205659@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9205 SW Barnes Rd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.