NPIMap

Individual provider Active NPI

Jeffrey Ryan Gourley, M.D.

  • Vascular & Interventional Radiology Physician
  • Norfolk, VA
National Provider Identifier
1194969204
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
0101245462 Issued in VA
Practice address
110 Kingley Lane
Suite 305
Norfolk, VA 23505-4617
Phone
(757) 889-5942
Fax
(757) 889-5450
NPI assigned
Apr 21, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101245462 VA
Vascular & Interventional Radiology Physician 2085R0204X 0101245462 VA Primary

Addresses

Primary practice location

110 Kingley Lane
Suite 305
Norfolk, VA 23505-4617

Mailing address

110 Kingsley LN Ste 305
Norfolk, VA 23505-4617
Phone (757) 889-5422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110517000827 VA Practitioner - Diagnostic Radiology 0143371914 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Eastern Virginia Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hampton Roads Radiology Associates, PCGroup PAC ID 4880688506, 39 clinicians
Radiology and Medical Imagery of Newnan PCGroup PAC ID 5395738348, 38 clinicians

Practice addresses (Care Compare)

150 Kingsley LN
Norfolk, VA 23505-4602
Phone (757) 916-9630

1500 Watersedge Dr
Virginia Beach, VA 23452-6224
Phone (770) 400-1000

Hospital & facility affiliations

  • Sentara Virginia Beach General Hospital Hospital, Virginia Beach, VA, CCN 490057
  • Sentara Obici Hospital Hospital, Suffolk, VA, CCN 490044
  • Sentara Princess Anne Hospital Hospital, Virginia Beach, VA, CCN 490119
  • Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215
  • Piedmont Newnan Hospital, Inc Hospital, Newnan, GA, CCN 110229

Merit-based Incentive Payment System (MIPS)

Final score
93.4 of 100Reported as group
Quality
100
Improvement activities
40
Cost
77.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hampton Roads Radiology Associates, PC Diagnostic Radiology CurrentSince Jan 22, 2011 Accepting new patients
Kingsley Lane Anatomic Pathology Current Accepting new patients
Northern Virginia Radiology Consultants, PLLC Diagnostic Radiology Past Accepting new patients

Locations

150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944

582 Lynnhaven Pkwy
Ste 301
Virginia Beach, VA 23452
Phone (757) 916-9631

1060 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 395-2323

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1194969204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 KINGSLEY LN STE 305",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054617",
            "telephone_number": "757-889-5422",
            "fax_number": "757-889-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 KINGLEY LANE",
            "address_2": "SUITE 305",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054617",
            "telephone_number": "757-889-5942",
            "fax_number": "757-889-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURLEY",
        "first_name": "JEFFREY",
        "middle_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-21",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101245462",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "VA",
            "license": "0101245462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.