Active NPI
Stephen G Gonsalves, FNP, PHD
- Family Nurse Practitioner
- Washington, DC
National Provider Identifier
1205316759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R136201
- Practice address
- 500 12TH St SW
Washington, DC 20536-5098 - Phone
- (240) 853-5887
- NPI assigned
- Aug 15, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | R136201 | MD | |
| Family Nurse Practitioner | 363LF0000X | R136201 | MD | Primary |
Addresses
Primary practice location
500 12TH St SW
Washington, DC 20536-5098
Mailing address
217 Creek Valley LN
Rockville, MD 20850
Phone (240) 780-6799
Other practice location 1
10 Center Drive
Bethesda, MD 20814
Phone (240) 780-6799
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R136201 | MD | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534291200000",
"number": "1205316759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 CREEK VALLEY LN",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "20850",
"telephone_number": "240-780-6799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 12TH ST SW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "205365098",
"telephone_number": "240-853-5887"
}
],
"practiceLocations": [
{
"address_1": "10 Center Drive",
"address_purpose": "LOCATION",
"city": "Bethesda",
"state": "MD",
"postal_code": "20814",
"country_code": "US",
"telephone_number": "240-780-6799",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GONSALVES",
"first_name": "STEPHEN",
"middle_name": "G",
"credential": "FNP, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-15",
"last_updated": "2018-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "MD",
"license": "R136201",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R136201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.