NPIMap

Individual provider Active NPI

Gerardo R Melgar, MD

  • Internal Medicine Physician
  • Longview, WA
National Provider Identifier
1619903820
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00034077 Issued in WA
Practice address
784 14TH Ave
Longview, WA 98632-2315
Phone
(360) 703-6400
Fax
(360) 353-6411
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00034077 WA Primary

Addresses

Primary practice location

784 14TH Ave
Longview, WA 98632-2315

Mailing address

1057 12TH Ave
Longview, WA 98632-2509
Phone (360) 636-3892

Other practice location 1

1057 12th Ave
Longview, WA 98632-2509
Phone (360) 636-3892

Other identifiers 2

IdentifierTypeStateIssuer
1033177MedicaidWA
7086523MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20060309000300 WA Practitioner - Internal Medicine 9537176920 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
May accept Medicare assignment
Group practices
Cowlitz Family Health CenterGroup PAC ID 5991696395, 21 clinicians

Practice addresses (Care Compare)

784 14TH Ave
Longview, WA 98632-2315
Phone (360) 703-6400

Hospital & facility affiliations

  • Harbors Home Health / Hospice Home health agency, Hoquiam, WA, CCN 507020
  • Ocean Beach Hospital Hospital, Ilwaco, WA, CCN 501314
  • Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00034077WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cowlitz Family Health Center CurrentSince Jan 16, 2006 Accepting new patients
Cowlitz Family Health Center CurrentSince Jan 16, 2006 Accepting new patients
Cowlitz Family Health Center Past Accepting new patients
Cowlitz Family Health Center Past Accepting new patients

Locations

784 14th Ave
Longview, WA 98632
Phone (360) 425-6117

1057 12th Ave
Longview, WA 98632
Phone (360) 636-3892

Organizations & group practices 8

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 3

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1619903820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-414-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-703-6400",
            "fax_number": "360-353-6411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1057 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322509",
            "country_code": "US",
            "telephone_number": "360-636-3892",
            "fax_number": "360-414-1114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELGAR",
        "first_name": "GERARDO",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00034077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033177",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7086523",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.