Individual provider Active NPI

Rosa E Gonzales, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dublin, OH
National Provider Identifier
1104348499
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN.CNP.021170 Issued in OH
Practice address
525 Metro PL N Ste 100
Dublin, OH 43017-5343
Phone
(855) 289-1722
NPI assigned
Jul 9, 2017
Last updated
Oct 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNP.021170 OH Primary
Nurse Practitioner 363L00000X CNP.021170 OH

Addresses

Primary practice location

525 Metro PL N Ste 100
Dublin, OH 43017-5343

Mailing address

525 Metro PL N Ste 100
Dublin, OH 43017-5343
Phone (855) 289-1722

Other identifiers 1

IdentifierTypeStateIssuer
2910854MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20170822002024 OH Practitioner - Nurse Practitioner 6507138823 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Toledo College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

530 S Main St
Lima, OH 45804-1240
Phone (419) 222-1168

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CNP.021170OHMDNurse Practitioner
APRN.CNP.021170OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Miller Psychiatric Services Psychiatric/Mental Health CurrentSince Jun 3, 2024 Accepting new patients
Miller Psychiatric Services Psychiatric/Mental Health CurrentSince Jun 3, 2024 Accepting new patients
Family Resource Center of Northwest Ohio Inc CurrentSince May 4, 2020 Accepting new patients
Recovery Services of Northwest Ohio, Inc CurrentSince Sep 28, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

200 Van Gundy Dr
Bryan, OH 43506
Phone (419) 636-0410

511 Perry St
Defiance, OH 43512
Phone (419) 782-4933

530 S Main St
Lima, OH 45804
Phone (419) 222-1168

118 E Clinton St
Napoleon, OH 43545
Phone (419) 599-7040

5547 Mahoning Ave
Youngstown, OH 44515
Phone (267) 691-2800

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/rsnwo/r4/

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.

NPI Registry JSON

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

{
    "created_epoch": "1499558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1104348499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 METRO PL N STE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175343",
            "telephone_number": "855-289-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 METRO PL N STE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175343",
            "telephone_number": "855-289-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "ROSA",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-09",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.021170",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "CNP.021170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2910854",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

Verify at the official NPI Registry.