NPIMap

Individual provider Active NPI

Nathanael John Gong

  • Emergency Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1205394608
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO3320 Issued in NV
Practice address
657 N Town Center Dr
Las Vegas, NV 89144-6367
Phone
(702) 233-7000
NPI assigned
Mar 5, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DO3320 NV Primary

Addresses

Primary practice location

657 N Town Center Dr
Las Vegas, NV 89144-6367

Mailing address

657 N Town Center Dr
Las Vegas, NV 89144-6367
Phone (702) 233-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20230531003561 NV Practitioner - Emergency Medicine 2860859154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shadow Emergency Physicians PLLCGroup PAC ID 2860667375, 105 clinicians

Practice addresses (Care Compare)

620 Shadow LN
Las Vegas, NV 89106-4119
Phone (954) 939-5000

Hospital & facility affiliations

  • Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290021
  • Summerlin Hospital Medical Center Hospital, Las Vegas, NV, CCN 290041
  • Spring Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290046
  • Centennial Hills Hospital Medical Center Hospital, Las Vegas, NV, CCN 290054

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Apr 17, 2023 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Apr 17, 2023 Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

657 N Town Center Dr
Las Vegas, NV 89144
Phone (702) 233-7571

Organizations & group practices 2

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 12

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": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1205394608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 N TOWN CENTER DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891446367",
            "telephone_number": "702-233-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 N TOWN CENTER DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891446367",
            "telephone_number": "702-233-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONG",
        "first_name": "NATHANAEL",
        "middle_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-05",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "DO3320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.