Individual provider Active NPI

Kelly A Gorman, PSY.D

  • Psychologist
  • Bay Pines, FL
National Provider Identifier
1104992247
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY7263 Issued in FL
Practice address
10,000 Bay Pines Boulevard
Bay Pines, FL 33744
Phone
(727) 398-6661
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY7263 FL Primary

Addresses

Primary practice location

10,000 Bay Pines Boulevard
Bay Pines, FL 33744

Mailing address

10,000 Bay Pines Boulevard
Bay Pines, FL 33744
Phone (727) 398-6661

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

State licenses

LicenseStateTypeSpecialty
PY7263FLMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
John P McDonough III Psychologist PastSince Oct 1, 2004 Accepting new patients
GPS II Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1104992247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10,000 BAY PINES BOULEVARD",
            "city": "BAY PINES",
            "state": "FL",
            "postal_code": "33744",
            "telephone_number": "727-398-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10,000 BAY PINES BOULEVARD",
            "city": "BAY PINES",
            "state": "FL",
            "postal_code": "33744",
            "telephone_number": "727-398-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY7263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.