David Lake Gormsen, D.O.

Primary specialty

Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X

License

34002838 Issued in OH

Practice address

1320 Mercy Dr NW
Canton, OH 44708-2614

Phone

(330) 489-1074

Fax

(330) 489-1487

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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 OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Cleveland Clinic Mercy Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Medicare reassignment NPD
• Stark County Emergency Physicians, Inc

  • Emergency Care Clinic/Center
  • Canton, OH
  • NPI 1811940026
  NPD (past) Authorized official
• Modernpath Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Canton, OH
  • NPI 1841272705
  NPD

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619014602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4189 SONGBIRD TRL",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442242572",
            "telephone_number": "330-688-4160",
            "fax_number": "330-489-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1074",
            "fax_number": "330-489-1487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMSEN",
        "first_name": "DAVID",
        "middle_name": "LAKE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "OH",
            "license": "34002838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "34002838",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Satyn Gordon
• Shartez Gordon
• John William Gore
• Justina Gorman
• Laura B Gorman, CDCA
• Gorrell Counseling LLC
• John C Gorrell, LPCC
• Martha Sophia Gotham, LPC
• Nicholas Gotschall, APRN-CNP
• Victoria Gotschall

• Pediatric Emergency Medicine (Emergency Medicine) Physician in Canton, OH
• Providers in Canton, OH by specialty
• Pediatric Emergency Medicine (Emergency Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.