Jayme C Gongola, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1030351 Issued in WV

Practice address

812 Gorman Ave
Elkins, WV 26241-3181

Phone

(304) 637-3894

Fax

(304) 637-3435

NPI assigned

Jul 14, 2006

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

Medicare fee-for-service enrollment

Enrolled in WV

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516147200000",
    "number": "1235155029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413181",
            "telephone_number": "304-637-3894",
            "fax_number": "304-637-3435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413181",
            "telephone_number": "304-637-3894",
            "fax_number": "304-637-3435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONGOLA",
        "first_name": "JAYME",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2018-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "1030351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lynne Goins
• Elizabeth Ellen Golden, BA, PRSS
• Anna Goldizen
• Joann Goldizen
• Katlyn Goldizen
• Jenna Louise Gongola, OD
• Michelle Renee Good
• Faith Gordan
• David H Gordon
• Ardel William Delgado Gorospe, M.D.

• Physician Assistant in Elkins, WV
• Providers in Elkins, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.