John Burk Gossom, MD

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

MD00018422 Issued in WA

Practice address

689 Airport Center Dr
Ste B
Friday Harbor, WA 98250

Phone

(360) 378-1338

Fax

(360) 378-1830

NPI assigned

Nov 2, 2005

Last updated

Mar 4, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• San Juan Healthcare Associates PLLC

  • Rural Health Clinic/Center
  • Friday Harbor, WA
  • NPI 1356326565
  NPD (past) Authorized official
• San Juan Healthcare PC

  • Primary Care Clinic/Center
  • Friday Harbor, WA
  • NPI 1407055742
  Authorized official Same address or phone

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299196800000",
    "number": "1245221886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1550",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982501550",
            "telephone_number": "360-378-1338",
            "fax_number": "360-378-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 AIRPORT CENTER DR",
            "address_2": "STE B",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "98250",
            "telephone_number": "360-378-1338",
            "fax_number": "360-378-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSOM",
        "first_name": "JOHN",
        "middle_name": "BURK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "MD00018422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "98250A003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MD00018422",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "361929500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8937843",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "532300001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "8101404",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0152514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "5403470",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "5877GO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CHOICE",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEECH ST",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTHPLAN OF W",
            "identifier": "912109329",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Marvin Gaskill Sr., M.D
• Robert M Gerfy, B.A.
• Katherine Suzanne Getz, LMT, RPP, CSB
• Kimberly Anne Gilliland, M.A.
• Trisha Ginley, L AC
• Roy W. Graves, MD
• Ciely Ti Gray, LMP
• Susan R. Grout, MA, LMHC
• Mary Jo Groves, M.D.
• Melissa Ann Guard

• Geriatric Medicine (Family Medicine) Physician in Friday Harbor, WA
• Providers in Friday Harbor, WA by specialty
• Geriatric Medicine (Family Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.