Gerard John-Charles Coughlin, DPM RESIDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

PDT.0000615 Issued in CO

Practice address

1600 23Rd Ave
Greeley, CO 80634-6070

Phone

(970) 810-2847

Fax

(970) 810-2820

NPI assigned

Jan 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1104457159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-810-2847",
            "fax_number": "970-810-2820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Samuel Merritt University",
            "address_2": "3100 Telegraph Avenue",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "94609",
            "country_code": "US",
            "telephone_number": "805-437-9742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COUGHLIN",
        "first_name": "GERARD",
        "middle_name": "JOHN-CHARLES",
        "name_prefix": "Dr.",
        "credential": "DPM RESIDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-29",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "PDT.0000615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antonio Costantini, CRNA
• Joseph Cote, DPM
• Charlotte Cotter, LCSW
• Danielle N Cotton, BSW
• Alissa Coufal
• Counseling Clinic LLC
• County of Weld
• County of Weld Board of County Commissioners
• County of Weld Board of County Commissioners
• County of Weld Board of County Commissioners

• Student in an Organized Health Care Education/Training Program in Greeley, CO
• Providers in Greeley, CO by specialty
• Student in an Organized Health Care Education/Training Program in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.