NPIMap

Individual provider Active NPI

John Gambol, M.D.

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Placentia, CA
National Provider Identifier
1255339826
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
License
G87090 Issued in CA
Practice address
1041 E Yorba Linda Blvd Ste 203
Placentia, CA 92870-3762
Phone
(818) 709-8161
Fax
(818) 709-8160
NPI assigned
Jul 8, 2005
Last updated
Dec 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G87090 CA
Emergency Medicine Physician 207P00000X ME70844 FL
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X G87090 CA Primary

Addresses

Primary practice location

1041 E Yorba Linda Blvd Ste 203
Placentia, CA 92870-3762

Mailing address

PO Box 9126
Canoga Park, CA 91309-0126
Phone (818) 709-8161

Other identifiers 5

IdentifierTypeStateIssuer
ME70844OtherFLLICENSE#
58630OtherFLGRP# 98513
G87090OtherCALICENSE#
261062100MedicaidFL
606478700OtherFLDOL GRP#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20110607000248 CA Practitioner - Emergency MedicinePractitioner - Other (Physician) 3476519562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Miami, LM Miller School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1041 E Yorba Linda Blvd
Suite 203
Placentia, CA 92870-3762
Phone (714) 985-9110

38660 Medical Ctr Dr
Palmdale, CA 93551-4385
Phone (661) 949-6946

8565 Independence Ave
Apt 1
Canoga Park, CA 91304-2976
Phone (818) 709-8161

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1334
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G87090CAMDUndersea and Hyperbaric Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boxidara, Inc. Undersea and Hyperbaric Medicine CurrentSince Apr 24, 2011 Accepting new patients
Conemaugh Valley Memorial Hospital Emergency Medicine Past Accepting new patients
Bay Emergency Physician Specialists Inc Emergency Medicine Past Accepting new patients
Gulf Emergency Specialists PA Emergency Medicine Past Accepting new patients

Locations

1818 Verdugo Blvd
Ste 204
Glendale, CA 91208
Phone (818) 790-5529

38660 Medical Center Dr
Ste A150
Palmdale, CA 93551
Phone (661) 945-5571

1041 E Yorba Linda Blvd
Ste 203
Placentia, CA 92870
Phone (714) 985-9110

Interoperability endpoints

  • Direct secure messaging: jgambol@direct-address.org

Organizations & group practices 4

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 9

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": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1255339826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9126",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913090126",
            "telephone_number": "818-709-8161",
            "fax_number": "818-709-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 E YORBA LINDA BLVD STE 203",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703762",
            "telephone_number": "818-709-8161",
            "fax_number": "818-709-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOL",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G87090",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME70844",
            "primary": false
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "CA",
            "license": "G87090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE#",
            "identifier": "ME70844",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP# 98513",
            "identifier": "58630",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE#",
            "identifier": "G87090",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261062100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL GRP#",
            "identifier": "606478700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Placentia, CA

Sources for this page

Verify at the official NPI Registry.