Individual provider Active NPI

Sarah E Gough, NP

  • Women's Health Nurse Practitioner
  • Longview, TX
National Provider Identifier
1487089108
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
714260 Issued in TX
Practice address
802 Medical Circle
Suite 100
Longview, TX 75605-5100
Phone
(903) 757-6042
Fax
(903) 232-8213
NPI assigned
Sep 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 714260 TX Primary

Addresses

Primary practice location

802 Medical Circle
Suite 100
Longview, TX 75605-5100

Mailing address

PO Box 610393
Dallas, TX 75261-0393
Phone (903) 291-6187

Other identifiers 1

IdentifierTypeStateIssuer
325488002MedicaidTX

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131104000995 TX Practitioner - Nurse Practitioner 3870728694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

802 Medical Cir
Suite 100
Longview, TX 75605-5207
Phone (903) 757-6042

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
714260TXMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Clinicians of East Texas CurrentSince Sep 1, 2017 Accepting new patients

Locations

707 Hollybrook Dr
Ste 500
Longview, TX 75605
Phone (903) 232-8276

1009 N 4th St
Ste A
Longview, TX 75601
Phone (903) 757-3808

802 Medical Cir
Ste 100
Longview, TX 75605
Phone (903) 757-6042

Interoperability endpoints

  • Direct secure messaging: sarah.gough.1@23550.direct.athenahealth.com

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 2

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": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1487089108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-291-6187",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 MEDICAL CIRCLE",
            "address_2": "SUITE 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055100",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-8213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "SARAH",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "714260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "325488002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.