NPIMap

Individual provider Active NPI

Ernesto Gutierrez, MD

  • Rheumatology Physician
  • Lebanon, PA
National Provider Identifier
1255330718
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
MD428609 Issued in PA
Practice address
755 Norman Dr
Lebanon, PA 17042-7497
Phone
(717) 273-6706
Fax
(717) 273-1435
NPI assigned
Jul 18, 2005
Last updated
Feb 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X MD428609 PA Primary

Addresses

Primary practice location

755 Norman Dr
Lebanon, PA 17042-7497

Mailing address

755 Norman Dr
Lebanon, PA 17042-7497
Phone (717) 273-6706

Other identifiers 4

IdentifierTypeStateIssuer
50058270OtherPACAPITAL BLUE CROSS
1015455900001MedicaidPA
1552372OtherPAGATEWAY
GU136434OtherPAHIGHMARK BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20060620000140 PA Practitioner - RheumatologyPractitioner - Internal Medicine 6406886746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Washington University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

755 Norman Dr
Lebanon, PA 17042-7497
Phone (717) 273-6706

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD428609PAMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lebanon Internal Medicine Associates PC CurrentSince Jun 1, 2006 Accepting new patients
Lebanon Internal Medicine Associates, P.C. CurrentSince Jun 1, 2006 Accepting new patients

Locations

755 Norman Dr
Lebanon, PA 17042
Phone (717) 273-6706

Interoperability endpoints

  • Direct secure messaging: egutierrez@lima.medentdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1255330718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-273-6706",
            "fax_number": "717-273-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-273-6706",
            "fax_number": "717-273-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "ERNESTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "PA",
            "license": "MD428609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50058270",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015455900001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1552372",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "GU136434",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.