Individual provider Active NPI

Theotonius Juyen Gomes, DO

  • Internal Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1205276664
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101020779 Issued in MI
Practice address
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone
(269) 337-6345
NPI assigned
Jul 1, 2013
Last updated
Nov 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101020779 MI Primary
Pediatrics Physician 208000000X 5101020779 MI

Addresses

Primary practice location

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Mailing address

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Other practice location 1

601 John St # 74
Kalamazoo, MI 49007-5341
Phone (269) 341-8481

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20170609001190 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 5294965471 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Michigan University School of MedicineGroup PAC ID 7517113954, 76 clinicians
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-4347

601 John St
Kalamazoo, MI 49007-5341

601 John St
Kalamazoo, MI 49007-5377

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

Merit-based Incentive Payment System (MIPS)

Final score
97.1 of 100Reported as group
Quality
85.82
Promoting interoperability
100
Improvement activities
40
Cost
77.4

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101020779MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Lakeview Hospital Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Western Michigan University School of Medicine CurrentSince Jul 31, 2017 Accepting new patients
Bronson Methodist Hospital CurrentSince Jul 1, 2017 Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Current Accepting new patients
Bronson Lakeview Hospital CurrentSince Jul 1, 2017 Accepting new patients
Beacon Kalamazoo Inc Past Accepting new patients
Bronson Methodist Hospital Past Accepting new patients

Locations

1000 Oakland Dr
Kalamazoo, MI 49008
Phone (269) 337-4347

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
#74
Kalamazoo, MI 49007
Phone (269) 341-8481

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1205276664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 John St # 74",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-8481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMES",
        "first_name": "THEOTONIUS",
        "middle_name": "JUYEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-01",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101020779",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101020779",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.