Individual provider Active NPI

Fabian J Gomez, PA

  • Physician Assistant
  • San Antonio, TX
National Provider Identifier
1639241805
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA05060 Issued in TX
Practice address
520 Madison Oak Dr
San Antonio, TX 78258-3913
Phone
(210) 297-4000
NPI assigned
Nov 14, 2006
Last updated
Jun 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA05060 TX Primary

Addresses

Primary practice location

520 Madison Oak Dr
San Antonio, TX 78258-3913

Mailing address

7703 Floyd Curl Dr # Mc7977
San Antonio, TX 78229-3901
Phone (210) 358-4000

Other practice location 1

520 Madison Oak Dr
San Antonio, TX 78258-3913
Phone (210) 297-4000

Other practice location 2

4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-4000

Other identifiers 3

IdentifierTypeStateIssuer
184599210MedicaidTX
184599211OtherTXCSHCN
184599201MedicaidTX

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070301000450 TX Practitioner - Physician Assistant 0941302418 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Services of TX, PLLCGroup PAC ID 3375909351, 374 clinicians

Practice addresses (Care Compare)

20475 Hwy 46 W
Suite 100
Spring Branch, TX 78070-6147
Phone (830) 438-6911

4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-4000

7703 Floyd Curl Dr
San Antonio, TX 78229-3901
Phone (210) 450-9000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
52764CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Health Science Center at San Antonio CurrentSince Jun 4, 2018 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince Jun 4, 2018 Accepting new patients
Third Coast Emergency Physicians Sid Peterson PA Past Accepting new patients

Locations

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

520 Madison Oak Dr
San Antonio, TX 78258
Phone (210) 297-0412

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

7703 Floyd Curl Dr
#7977
San Antonio, TX 78229
Phone (210) 292-0400

8811 Village Dr
San Antonio, TX 78217
Phone (210) 297-2000

1215 E Court St
Seguin, TX 78155
Phone (830) 379-2411

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1639241805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR # MC7977",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293901",
            "telephone_number": "210-358-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MADISON OAK DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583913",
            "telephone_number": "210-297-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Madison Oak Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782583913",
            "country_code": "US",
            "telephone_number": "210-297-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-358-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "FABIAN",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184599210",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "184599211",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184599201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.