Larry Kyle Gambrell, D.O.

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

20A9837 Issued in CA

Practice address

6880 Palm Avenue
Sebastopol, CA 95472

Phone

(707) 823-7628

Fax

(707) 823-1521

NPI assigned

Oct 10, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in ID

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 1

Specialty

Otolaryngology

Education

Oklahoma State University College of Osteopathic Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caribou Memorial HospitalGroup PAC ID 6103734777, 15 clinicians

Caribou Medical Center, IncGroup PAC ID 7618365701, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Caribou Medical Center Hospital, Soda Springs, ID, CCN 131309
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Merit-based Incentive Payment System (MIPS)

Final score

93.65 of 100Reported as group

Quality

86.8

Promoting interoperability

100

Improvement activities

40

Cost

86.36

Merit-based Incentive Payment System (MIPS)

Final score

92.39 of 100Reported as group

Quality

83.33

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Caribou Medical Center, Inc

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Medicare reassignment Care Compare group NPD
• Caribou Medical Center, Inc

  • Rural Health Clinic/Center
  • Soda Springs, ID
  • NPI 1548930878
  NPD
• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  NPD (past)
• Tele-Medicine Services Ny, PLLC

  • Internal Medicine Physician
  • Roseville, CA
  • NPI 1609663780
  NPD (past)

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

• Caribou Medical Center, Inc

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Care Compare affiliation
• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1275621963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6880 PALM AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724270",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6880 PALM AVENUE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "95472",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBRELL",
        "first_name": "LARRY",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "CA",
            "license": "20A9837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CA107813",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Vittoria Frattolillo, AMFT 92158
• Toby Ellen French, MFT
• Jennifer Frendo, M.S. CCC-SLP
• David Fromm, M.D.
• Full Circle Psychotherapy
• Cecille M Gannon, PSYD
• Marisa Carey Gardner
• Deborah Gail Garner-Hale, M. ED.
• Elaine Sohier Gayler, M.A.
• Danielle Ghilotti

• Otolaryngology/Facial Plastic Surgery Physician in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Otolaryngology/Facial Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.