Kate Roxalyn Gazenko, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

E9331 Issued in AR

Practice address

1 Medicine Dr
Clarksville, AR 72830-4431

Phone

(479) 754-6510

Fax

(479) 754-5644

NPI assigned

Jun 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY, AR, CO3 enrollments

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 3

Specialty

General Surgery

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Physician Services LLCGroup PAC ID 4981698032, 49 clinicians

Upper San Juan Health Service DistrictGroup PAC ID 2769571892, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson Regional Medical Center Hospital, Clarksville, AR, CCN 040002
• Pagosa Springs Medical Center Hospital, Pagosa Springs, CO, CCN 061328

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kate.gazenko.1@22932.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/22932/brand/1/csg/1/fhir/r4

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.

• St Mary's Physician Services LLC

  • General Practice Physician
  • Russellville, AR
  • NPI 1124084991
  Medicare reassignment Care Compare group NPD
• Upper San Juan Health Service District

  dba Pagosa Springs Medical Center

  • Critical Access Hospital
  • Pagosa Springs, CO
  • NPI 1245401561
  Medicare reassignment Care Compare group
• Gazenko Aesthetics LLC

  • Surgery Physician
  • Clarksville, AR
  • NPI 1932092053
  NPD Authorized official
• Gazenko Surgical Services, PLLC

  dba Gazenko Surgical & Cosmetics Center

  • Surgery Physician
  • Clarksville, AR
  • NPI 1225629652
  NPD Authorized official
• Johnson Regional Medical Center

  dba Johnson County Surgery Clinic

  • Surgery Physician
  • Clarksville, AR
  • NPI 1275558710
  Medicare reassignment
• St Marys Physician Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Russellville, AR
  • NPI 1063626117
  NPD
• Johnson Regional Medical Center

  dba Johnson Regional Medical Center Orthopedic Clinic

  • Orthopaedic Surgery Physician
  • Clarksville, AR
  • NPI 1639557226
  NPD (past)
• St Marys Physician Services, LLC

  dba Cardiology Associates of North Central Arkansas

  • Interventional Cardiology Physician
  • Russellville, AR
  • NPI 1720356207
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Johnson Regional Medical Center

  • General Acute Care Hospital
  • Clarksville, AR
  • NPI 1134116049
  Care Compare affiliation
• Upper San Juan Health Service District

  dba Pagosa Springs Medical Center

  • Critical Access Hospital
  • Pagosa Springs, CO
  • NPI 1245401561
  Care Compare affiliation

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1245435213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W MAIN ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303417",
            "telephone_number": "479-705-2310",
            "fax_number": "479-705-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICINE DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304431",
            "telephone_number": "479-754-6510",
            "fax_number": "479-754-5644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 W Main St",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "AR",
            "postal_code": "728303417",
            "country_code": "US",
            "telephone_number": "479-705-2310",
            "fax_number": "479-705-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAZENKO",
        "first_name": "KATE",
        "middle_name": "ROXALYN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.099672",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E9331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210971001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Leigh Garrison, OT-A
• Susan Gateley, A.P.N.
• Ashley N Gattis, NP
• Gazenko Aesthetics LLC
• Gazenko Surgical Services, PLLC (Gazenko Surgical & Cosmetics Center)
• Loretta J Gedosh, LPC
• Sydni Gibbs
• Alonzo Gilbert
• Gill-West Companies, Inc. (River Valley Medical Supply)
• Jamie Gilmer, RECOVERY ADVOCATE

• Surgery Physician in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.