Jennifer W Gonzalez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.007105RX Issued in OH

Practice address

725 University Blvd
Beavercreek, OH 45324-2640

Phone

(937) 245-7200

Fax

(937) 245-7999

NPI assigned

Oct 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH, TN2 enrollments

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 2

Specialty

Physician Assistant

Education

Medical University of South Carolina College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kca, PLLCGroup PAC ID 1557436565, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vanderbilt Clarksville Hospital Hospital, Clarksville, TN, CCN 440035

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ABAFDD/Endpoint/ABAFDD
• Direct secure messaging: jgonzalez@hardinmemorial.gwaydirect.com
• Direct secure messaging: jennifer.gonzalez@779530956636164.direct.elationemr.com

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.

• Kca, PLLC

  • Specialist
  • Franklin, TN
  • NPI 1407025380
  Medicare reassignment Care Compare group
• Wright State Physicians Inc

  • Ambulatory Surgical Clinic/Center
  • Dayton, OH
  • NPI 1649447582
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Clarksville Health System, LLC

  • General Acute Care Hospital
  • Clarksville, TN
  • NPI 1285689794
  Care Compare affiliation

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

{
    "created_epoch": "1192320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1154519239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 UNIVERSITY BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453242640",
            "telephone_number": "937-245-7200",
            "fax_number": "937-245-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 UNIVERSITY BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453242640",
            "telephone_number": "937-245-7200",
            "fax_number": "937-245-7999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13330 Usf Laurel Dr",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "33612",
            "country_code": "US",
            "telephone_number": "813-974-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "JENNIFER",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-14",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112057",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007105RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104159800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0462499",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0EJPX",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Sean Gilmore, PT
• Lyrice W Gladwill
• Elizabeth Gleason, PA
• Paul Robert Glowienka, M.D.
• Suman Goel
• Good Morning Physical Therapy and Rehab
• Patricia A. Gooding, M.S. LPCC
• Lisa Kay Goodrich, APRN
• Theresia Gordnier
• Gordon W Womack DDS Inc

• Physician Assistant in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.