Suzanne M Gongloff, PA
Individual provider Active NPI Medical Physician Assistant · Winchester, VA
NPI 1477532935 · NPPES record last updated Feb 24, 2010
Key facts
- NPI
- 1477532935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 0110001482 (VA)
- Practice address
- 104 Selma Dr
Winchester, VA 22601-3834 - Phone
- (540) 678-2800
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Selma Medical Assoc Inc
Practice addresses (Care Compare)
104 Selma Dr
Winchester, VA 22601-3834
Phone (540) 678-2800
Hospital & facility affiliations
- Valley Health Home Health
- Winchester Medical Center
- Warren Memorial Hospital
- Hampshire Memorial Hospital
- Shenandoah Memorial Hospital
- Berkeley Medical Center
- The Village at Orchard Ridge
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100317000185 | VA | Practitioner - Physician Assistant | 8921133877 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- suzanne.gongloff@direct.selma.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110001482 | VA | Yes |
Addresses
Primary practice location
104 Selma Dr
Winchester, VA 22601-3834
Mailing address
104 Selma Dr
Winchester, VA 22601-3834
Phone (540) 678-2800
Other providers in Winchester, VA
- David Felheimer Goldberg
- Jacqueline Golden
- Alla Yurievna Golovkina-Hynes
- Megan S Gomes Ruotolo
- William Arthur Gomke
- Natali Alejandra Gonzalez
- Samantha J Gonzalez
- Stacey Cathleen Good
- Terral Goode
- John Lewis Goodloe III
All providers in Winchester, VA · Medical Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.