Susana Gomilla, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9032-1 Issued in NY

Practice address

5645 Main St
Department of OB/GYN
Flushing, NY 11355-5045

Phone

(718) 670-1517

NPI assigned

Jul 18, 2008

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

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: sug9027@direct.nyp.org

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.

• New York Queens Medicine and Surgery, P.C.

  dba Newyork-Presbyterian Medical Group/Queens

  • Pediatrics Physician
  • Fresh Meadows, NY
  • NPI 1003114851
  Medicare reassignment NPD

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1487819439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "address_2": "DEPARTMENT OF OB/GYN",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "address_2": "DEPARTMENT OF OB/GYN",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMILLA",
        "first_name": "SUSANA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-18",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "9032-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "5645 Main St",
            "address_2": "Department of Ob/Gyn",
            "city": "Flushing",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113555045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "fhir",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "5645 Main St",
            "address_2": "Department of Ob/Gyn",
            "city": "Flushing",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113555045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sug9027@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "direct messaging address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct messaging address",
            "address_1": "5645 Main St",
            "address_2": "Department of Ob/Gyn",
            "city": "Flushing",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113555045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Judah M Gomberg, DPM
• Gerson Ives Gomes, M.D.
• Kathleen Dominica Gomes
• Ariana Nicole Gomez
• Glendalee Gomez, RN
• Katherine Gon
• Fenrong Gong, PHYSICAL THERAPY
• Sujeong Gong
• Weijia Gong, LMHC
• Kimberly Gonzalez, RPA-C

• Physician Assistant in Flushing, NY
• Providers in Flushing, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.