Gayle A Pugh

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00890 Issued in TX

Practice address

35607 Hwy 96 South
Buna, TX 77612

Phone

(409) 994-9323

Fax

(409) 994-9290

NPI assigned

Jul 1, 2006

Last updated

Oct 20, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX2 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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184653354. Details of each certification follow.

• CCN 673844 Rural health clinic · Active · Details

Rural health clinic certification: CCN 673844

Legal name

BUNA MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 15, 2002

Last certification

Jul 18, 2017

Ownership / control type

1A

Organization structure

OtherProprietary

Incorporated

in TX

Enrollment address

35607 Highway 96 S
Buna, TX 77612-6600

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Buna Medical Clinic

  • Rural Health Clinic/Center
  • Buna, TX
  • NPI 1306066568

  O20060404000063

  Same enrollment

Specialty

Physician Assistant

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Buna Medical Clinic

  • Rural Health Clinic/Center
  • Buna, TX
  • NPI 1306066568

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Emergency Physician Associates, P.a.

  • Emergency Medicine Physician
  • Beaumont, TX
  • NPI 1235155102
  NPD (past)

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224460800000",
    "number": "1184653354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2279",
            "city": "BUNA",
            "state": "TX",
            "postal_code": "77612",
            "telephone_number": "409-994-9323",
            "fax_number": "409-994-9290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35607 HWY 96 SOUTH",
            "city": "BUNA",
            "state": "TX",
            "postal_code": "77612",
            "telephone_number": "409-994-9323",
            "fax_number": "409-994-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "GAYLE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2008-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153391101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Lyn Nuss
• Janet Okun
• Dimitra Papadopoulos, PHARMD
• Erin Neff Peters, LMT
• Private Healthcare Facilities
• Darby Reed, LPA
• Ceaetta Harris Renfro
• Resilient Minds PLLC
• Sovereign T Farm
• Paula Renee Tacker, LMSW

• Physician Assistant in Buna, TX
• Providers in Buna, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.