Nicole Gourmelon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12749 Issued in TX

Practice address

1515 Holcombe Blvd
Houston, TX 77030-4000

Phone

(713) 792-6161

NPI assigned

Jun 2, 2019

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 3

Other names 1

• Nicole Elizabeth Cordner Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Baylor College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Referral ServiceGroup PAC ID 7911801410, 2,728 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Texas M D Anderson Cancer Center Hospital, Houston, TX, CCN 450076

Merit-based Incentive Payment System (MIPS)

Final score

84.29 of 100Reported as group

Quality

70.82

Promoting interoperability

100

Improvement activities

40

Cost

67.65

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: ngourmelon139772@utmdandersoncc.direct-ci.com

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.

• Physicians Referral Service

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1073574810
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of Texas M. D. Anderson Cancer Center

  • General Acute Care Hospital
  • Houston, TX
  • NPI 1174582050
  Care Compare affiliation

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

{
    "created_epoch": "1559433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1629636972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 4439",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104439",
            "telephone_number": "713-792-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304000",
            "telephone_number": "713-792-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURMELON",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-02",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LT455",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN (MEDICAID)",
            "identifier": "402724502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402724501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "CORDNER",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Violet Gould
• Alison N Goulding, MD
• Luana Goulet
• Sushanth Gouni, MD
• Shemika Lutwiane Gourdine
• Snigda Goutareddy, DMD
• Michael Goutnik, MD
• Josue Govea
• Yongson Govea, OD
• Erica Fatima Govind-Feist, LCSW

• Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; 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.