Emily Grace Gouker, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10003411A Issued in IN

Practice address

270 E Day Rd Ste 280
Mishawaka, IN 46545-3452

Phone

(574) 271-0268

Fax

(574) 271-0395

NPI assigned

Oct 5, 2021

Last updated

Oct 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: emily.gouker.1@13813.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Del Pilar Medical & Urgent Care PC

  • Geriatric Medicine (Family Medicine) Physician
  • Mishawaka, IN
  • NPI 1417031907
  Medicare reassignment

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1447922638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 E DAY RD STE 280",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453452",
            "telephone_number": "574-271-0268",
            "fax_number": "574-271-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E DAY RD STE 280",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453452",
            "telephone_number": "574-271-0268",
            "fax_number": "574-271-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUKER",
        "first_name": "EMILY",
        "middle_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10003411A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092300",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000090717",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MIDICARE",
            "identifier": "110052119",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "secure",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "270 E Day Rd Ste 280",
            "city": "Mishawaka",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465453452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cory Goodson
• Gina Gordenier
• Amanda Gordillo, MA, RD, LD
• Aviva Gordon
• Heather Gordy, NP
• Kayla Gowen
• Mary Evelyn Graber, M.D.
• Michael F Grantham, MD
• Kristin Grathen, RN
• Annemarie Catherine Gray, BCBA

• Medical Physician Assistant in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Medical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.