Active NPI
K G Gauntt DPM PC
- Podiatrist
- Newberg, OR
National Provider Identifier
1275770349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- DP00197
- Legal business name
- K G GAUNTT DPM PC
- Practice address
- 410 Villa Road
Newberg, OR 97132 - Phone
- (503) 538-0466
- Fax
- (503) 538-0913
- NPI assigned
- Jan 12, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kim Gary Gauntt, DPM
- Title
- President
- Phone
- (503) 538-0466
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | DP00197 | OR | Primary |
Addresses
Primary practice location
410 Villa Road
Newberg, OR 97132
Mailing address
410 Villa Road
Newberg, OR 97132
Phone (503) 538-0466
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001656 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- K G Gauntt DPM
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Tuality Podiatry
- Durable Medical Equipment & Medical Supplies
- Newberg, OR
- NPI 1871739482
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Podiatrist
- Newberg, OR
- NPI 1902908171
-
- Foot & Ankle Surgery Podiatrist
- Salem, OR
- NPI 1497149454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231718400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1231718400000",
"number": "1275770349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 VILLA ROAD",
"city": "NEWBERG",
"state": "OR",
"postal_code": "97132",
"telephone_number": "503-538-0466",
"fax_number": "503-538-0913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 VILLA ROAD",
"city": "NEWBERG",
"state": "OR",
"postal_code": "97132",
"telephone_number": "503-538-0466",
"fax_number": "503-538-0913"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "K G GAUNTT DPM PC",
"organizational_subpart": "NO",
"enumeration_date": "2009-01-12",
"last_updated": "2009-01-12",
"status": "A",
"authorized_official_last_name": "GAUNTT",
"authorized_official_first_name": "KIM",
"authorized_official_middle_name": "GARY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "503-538-0466",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "OR",
"license": "DP00197",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001656",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.