Active NPI
Edgardo Gamboa, MD
- Neurology Physician
- Hays, KS
National Provider Identifier
1104890805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 0429376
- Practice address
- 2214 Canterbury Dr
Suite 314
Hays, KS 67601-2375 - Phone
- (785) 623-2326
- Fax
- (785) 623-2331
- NPI assigned
- Feb 17, 2006
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 0429376 | KS | Primary |
Addresses
Primary practice location
2214 Canterbury Dr
Suite 314
Hays, KS 67601-2375
Mailing address
2214 Canterbury Dr
Suite 314
Hays, KS 67601-2375
Phone (785) 623-2326
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100168010B | Medicaid | KS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0429376 | KS | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hays Medical Center, Inc. | Neurology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260921600000",
"number": "1104890805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2214 CANTERBURY DR",
"address_2": "SUITE 314",
"city": "HAYS",
"state": "KS",
"postal_code": "676012375",
"telephone_number": "785-623-2326",
"fax_number": "785-623-2331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2214 CANTERBURY DR",
"address_2": "SUITE 314",
"city": "HAYS",
"state": "KS",
"postal_code": "676012375",
"telephone_number": "785-623-2326",
"fax_number": "785-623-2331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "EDGARDO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2009-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "KS",
"license": "0429376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100168010B",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hays, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.