NPIMap

Individual provider Active NPI

Trinley Gongya, MD

  • Family Medicine Physician
  • Brockton, MA
National Provider Identifier
1487149530
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
286376 Issued in MA
Practice address
110 Liberty St
Brockton, MA 02301-5674
Phone
(508) 894-0412
NPI assigned
Jun 29, 2018
Last updated
Oct 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 286376 MA Primary

Addresses

Primary practice location

110 Liberty St
Brockton, MA 02301-5674

Mailing address

110 Liberty St
Brockton, MA 02301-5674
Phone (508) 941-7000

Other practice location 1

2600 Sixth St SW
Canton, OH 44710-1702
Phone (330) 363-6211

Other practice location 2

45 Dimock St
Roxbury, MA 02119-1208
Phone (617) 442-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210908001218 MA Practitioner - Family Practice 3971909516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Healthcare Medical Group IncGroup PAC ID 7719876267, 250 clinicians

Practice addresses (Care Compare)

110 Liberty St
Brockton, MA 02301-5521
Phone (508) 894-0400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Healthcare Medical Group Inc Family Medicine CurrentSince Sep 1, 2024 Accepting new patients
West Bridgewater Medical Investors, LLC Past Accepting new patients
Brockton Rehabilitation and Nursing Center LLC Past Accepting new patients
Copley Health Care Partnership Past Accepting new patients
Alliance Health of Brockton, Inc. Past Accepting new patients

Locations

110 Liberty St
Brockton, MA 02301

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

Interoperability endpoints

  • Direct secure messaging: trinley.gongya@direct.signature.masshiway.net

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1530230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1487149530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015674",
            "telephone_number": "508-941-7000",
            "fax_number": "508-941-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015674",
            "telephone_number": "508-894-0412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Sixth St SW",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447101702",
            "country_code": "US",
            "telephone_number": "330-363-6211",
            "fax_number": "330-453-4263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "45 Dimock St",
            "address_purpose": "LOCATION",
            "city": "Roxbury",
            "state": "MA",
            "postal_code": "021191208",
            "country_code": "US",
            "telephone_number": "617-442-8800",
            "fax_number": "617-541-8472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONGYA",
        "first_name": "TRINLEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-29",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "286376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.