Kimberley F Gangwish, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

427 Issued in NE

Practice address

620 N Diers Ave
Ste 200
Grand Island, NE 68803-4984

Phone

(308) 384-5400

Fax

(308) 384-5201

NPI assigned

May 28, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

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

Specialty

Physician Assistant

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premise Health of Nevada Medical Hinitt P CGroup PAC ID 7214822030, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Premise Health of Nevada Medical Hinitt P C

  • Family Medicine Physician
  • Grand Island, NE
  • NPI 1023172277
  Medicare reassignment Care Compare group
• Premise Health of Nevada Medical Hinitt PC

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
  • NPI 1649977067
  NPD
• Foot & Ankle Clinic of Central Nebraska PC

  • Podiatrist
  • Grand Island, NE
  • NPI 1134162910
  NPD (past)

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

{
    "created_epoch": "1117238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191283200000",
    "number": "1598768046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N DIERS AVE",
            "address_2": "STE. 200",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034984",
            "telephone_number": "308-384-5400",
            "fax_number": "308-384-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N DIERS AVE",
            "address_2": "STE 200",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034984",
            "telephone_number": "308-384-5400",
            "fax_number": "308-384-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGWISH",
        "first_name": "KIMBERLEY",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-28",
        "last_updated": "2007-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NE",
            "license": "427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47054564512",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Galvan
• Jennifer A Galvan, RN
• Rodney Galvan
• Melody Gamero Guerra
• Nora Gangra
• Jennifer Gannon
• Karlaisabel Garcia Alvarez
• Marileidy Garcia Guillen
• Daniel Aaron Garcia-Mencia
• Alexa Isabel Garcia

• Surgical Physician Assistant in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Surgical Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.