Stasha Gominak, MD, PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

STASHA GOMINAK, MD, PA

Practice address

700 Olympic Plaza Cir
Suite 912
Tyler, TX 75701-1951

Phone

(903) 596-3808

Fax

(903) 596-3815

NPI assigned

Dec 7, 2007

Last updated

Sep 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stasha C Gominak, M.D.NPI 1659486116

Title

Physician

Phone

(903) 596-3808

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stasha C Gominak, MD

  • Neurology Physician
  • Tyler, TX
  • NPI 1659486116
  Authorized official Same address or phone

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1356524862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR",
            "address_2": "912",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011951",
            "telephone_number": "903-596-3808",
            "fax_number": "903-596-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR",
            "address_2": "SUITE 912",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011951",
            "telephone_number": "903-596-3808",
            "fax_number": "903-596-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STASHA GOMINAK, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "GOMINAK",
        "authorized_official_first_name": "STASHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "903-596-3808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0086KV",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB5632",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164213401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corey Starks, MOTR
• Myeeseia Starling
• William H Starling, MD
• Amy M Starr, MD
• Madisen Starr
• State of Texas Veterans Land Board (Watkins-Logan-Garrison Texas State Veterans Home)
• Delana Deneise Staten, RPH
• Kristin Staudinger
• Stedeyo Nemt LLC
• Jennifer A Steeger, MD

• Neurology Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Neurology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.