Individual provider Active NPI

Animesh Chidanandrao Gour, MD

  • Pulmonary Disease Physician
  • Erie, PA
National Provider Identifier
1477994713
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD459404 Issued in PA
Practice address
204 W 26TH St
Erie, PA 16508-1806
Phone
(347) 981-5667
NPI assigned
Jul 16, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X MD459404 PA Primary

Addresses

Primary practice location

204 W 26TH St
Erie, PA 16508-1806

Mailing address

204 W 26TH St
Erie, PA 16508-1806
Phone (814) 864-4755

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address agour226448@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20230330003095 TX Practitioner - Pulmonary Disease 1153656418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Ips LLCGroup PAC ID 9638356801, 44 clinicians

Practice addresses (Care Compare)

4458 Medical Dr
Suite 505
San Antonio, TX 78229-3748
Phone (210) 690-7400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD459404PAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Ips LLC Pulmonary Disease CurrentSince Mar 1, 2023 Accepting new patients

Locations

4458 Medical Dr
Ste 505
San Antonio, TX 78229

4499 Medical Dr
#150
San Antonio, TX 78229
Phone (210) 614-8181

Interoperability endpoints

  • Direct secure messaging: agour226448@direct.ahn.org

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1477994713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W 26TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165081806",
            "telephone_number": "814-864-4755",
            "fax_number": "814-864-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W 26TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165081806",
            "telephone_number": "347-981-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUR",
        "first_name": "ANIMESH",
        "middle_name": "CHIDANANDRAO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-16",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "MD459404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agour226448@direct.ahn.org",
            "affiliation": "N",
            "address_1": "204 W 26th St",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165081806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.