Stormie Rae Gough, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS022997 Issued in PA

Practice address

1200 S Cedar Crest Blvd FL 6
Allentown, PA 18103-6202

Phone

(610) 402-7712

NPI assigned

May 23, 2020

Sex

Female

Sole proprietor

No

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.

• St. Joseph Medical Group

  • Family Medicine Physician
  • Reading, PA
  • NPI 1184754657

  PA, Pediatrics

  Medicare reassignment NPD
• Lehigh Valley Physician Group

  • Psychiatry Physician
  • Bethlehem, PA
  • NPI 1164666376
  NPD
• Lehigh Valley Physician Group

  • Family Medicine Physician
  • East Stroudsburg, PA
  • NPI 1245093368
  NPD
• Lehigh Valley Physician Group

  • Transplant Surgery Physician
  • Allentown, PA
  • NPI 1457309650

  Pediatrics

  NPD
• St. Joseph Medical Group

  • Anesthesiology Physician
  • Reading, PA
  • NPI 1841680881
  NPD
• Lehigh Valley Hospital

  • General Acute Care Hospital
  • Allentown, PA
  • NPI 1164400131
  NPD (past)
• Lehigh Valley Hospital

  • Children's Hospital
  • Allentown, PA
  • NPI 1952954307
  NPD (past)
• St Joseph Regional Health Network

  • General Acute Care Hospital
  • Reading, PA
  • NPI 1699734665
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swagner339689@direct2.lvhn.org

• Stormie Rae Wagner Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 10, 2023.

{
    "created_epoch": "1590192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1164045209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD FL 6",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202",
            "telephone_number": "610-402-7712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "STORMIE",
        "middle_name": "RAE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-23",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OT020219",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "PA",
            "license": "OS022997",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS022997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STORMIE",
            "last_name": "WAGNER",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Goshen Group Home LLC
• Goshen Total Care
• Nissa J Gossom, CNM
• Got Your 6 Counseling, LLC
• Abigail Gotsch, MD
• Regina Gourniak, OTR-L
• Richard Frank Goy, M.D., M.P.H.
• Abhinav Goyal, M.D.
• Shriya Goyal
• Terrence Goyke, DO

• All providers in Allentown, PA
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.