Erica Ambrozevicius Gomez, DMSC, MPAP, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17475 Issued in CA

Practice address

2251 N Harbor Blvd
Fullerton, CA 92835-2601

Phone

(714) 449-6230

Fax

(714) 449-1773

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Erica Lopez Ambrozevicius Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Pih Health PhysiciansGroup PAC ID 8426951328, 616 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: egomez2048121@oc.providencedirect.org

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.

• Pih Health Physicians

  • Family Medicine Physician
  • Whittier, CA
  • NPI 1609233899
  Medicare reassignment Care Compare group
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group
• Gomez Health, a Physician Assistant Corporation

  • Family Medicine Physician
  • Orange, CA
  • NPI 1184302374
  NPD Authorized official
• Orange County Urgent Care #3, Inc.

  • Urgent Care Clinic/Center
  • Long Beach, CA
  • NPI 1619445111
  NPD
• Pih Health Physicians

  • Anesthesiology Physician
  • Downey, CA
  • NPI 1447931506
  NPD
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1316044282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 SAN JOSE AVE",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906315035",
            "telephone_number": "626-383-4264",
            "fax_number": "562-451-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352601",
            "telephone_number": "714-449-6230",
            "fax_number": "714-449-1773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1820 W Orangewood Ave",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928682043",
            "country_code": "US",
            "telephone_number": "657-246-3658",
            "fax_number": "562-451-3026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5630 E Santa Ana Canyon Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928073122",
            "country_code": "US",
            "telephone_number": "714-974-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "ERICA",
        "middle_name": "AMBROZEVICIUS",
        "credential": "DMSC, MPAP, PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "scuhs.edu",
            "affiliation": "N",
            "endpointDescription": "University web",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "no health information",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "not in use",
            "address_1": "2100 San Jose Ave",
            "city": "LA Habra",
            "state": "CA",
            "country_code": "US",
            "postal_code": "906315035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://ehr2.charmtracker.com/ehr/main.do",
            "affiliation": "N",
            "endpointDescription": "electronic medical record software",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "emr",
            "address_1": "1820 W Orangewood Ave",
            "city": "Orange",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928682043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "AMBROZEVICIUS",
            "middle_name": "LOPEZ",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sylvia Patricia Gomez-Morales, PH.D.
• Ana Gomez-Rodriguez
• Kenya Gomez-Tydor, M.A. SLP
• Danielle Yvonne Gomez, LAC
• Elizabeth Anne Gomez, AMFT
• Gisselle Gomez
• Jose Gomez
• Martha Evelyn Gomez
• Melanie Gomez
• Paola Gomez

• Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.