Evangeline Cua Gan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD00035936 Issued in WA

Practice address

12800 Bothell-Everett Hwy
Suite 190
Everett, WA 98208-6644

Phone

(425) 316-5160

Fax

(425) 225-1005

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: egan121936@wm.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.

• Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment NPD
• Providence Health & Services - Washington

  • Physical Medicine & Rehabilitation Physician
  • Everett, WA
  • NPI 1740432731
  NPD
• Providence Health & Services - Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1013169507

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1376644351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOTHELL-EVERETT HWY",
            "address_2": "SUITE 190",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086644",
            "telephone_number": "425-316-5160",
            "fax_number": "425-225-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAN",
        "first_name": "EVANGELINE",
        "middle_name": "CUA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00035936",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00035936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8231037",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egan121936@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12800 Bothell-Everett Hwy",
            "address_2": "Suite 190",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982086644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharon Galliher, REGISTERED NURSE
• Christopher Galstad
• Ruslan Galushkin
• Richard Dean Galuska
• Haydee Guadalupe Galvan Wali, M.A., CCC-SLP
• Marie Louise Gandee-Windhorn
• Kapil Gangwal, MBBS
• Anika Cole Gannon, CNM, DNP, ARNP
• Carl Gannon, PA
• Jenney Jenean Gannon, BSN,RN,INTERN

• Internal Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.