Active NPI
Owen Gonzalez, CPO
- Orthotist
- Jacksonville, NC
National Provider Identifier
1326620741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- CO006226
- Practice address
- 2680 Henderson Dr Ste 3
Jacksonville, NC 28546-5297 - Phone
- (910) 219-1455
- NPI assigned
- Apr 26, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | |||
| Orthotist | 222Z00000X | CO006226 | FL | Primary |
Addresses
Primary practice location
2680 Henderson Dr Ste 3
Jacksonville, NC 28546-5297
Mailing address
2680 Henderson Dr Ste 3
Jacksonville, NC 28546-5297
Phone (910) 219-1455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO006226 | FL | MD | Orthotist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adaptive Technologies LLC | Orthotist | Current | Accepting new patients |
Locations
2680 Henderson Dr
Ste 3
Jacksonville, NC 28546
Phone (910) 219-1455
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619395200000",
"number": "1326620741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2680 HENDERSON DR STE 3",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465297",
"telephone_number": "910-219-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2680 HENDERSON DR STE 3",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465297",
"telephone_number": "910-219-1455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "OWEN",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-26",
"last_updated": "2021-04-26",
"certification_date": "2021-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "FL",
"license": "CO006226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.