NPIMap

Individual provider Active NPI

Andre Jaylan Gomez, PA

  • Hospitalist Physician
  • Oklahoma City, OK
National Provider Identifier
1659095594
Registry record updated Dec 6, 2022
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Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
PA4953 Issued in OK
Practice address
700 NE 13TH St
Oklahoma City, OK 73104-5004
Phone
(405) 271-4700
NPI assigned
Oct 3, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4953 OK
Medical Physician Assistant 363AM0700X 4953 OK
Hospitalist Physician 208M00000X PA4953 OK Primary

Addresses

Primary practice location

700 NE 13TH St
Oklahoma City, OK 73104-5004

Mailing address

123 NE 2ND St Apt 311
Oklahoma City, OK 73104-2264
Phone (575) 390-4202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20221201002832 OK Practitioner - Physician Assistant 8022486687 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.26 of 100Reported as group
Quality
53.73
Promoting interoperability
100
Improvement activities
40
Cost
70.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4953OKMDDentist
PA4953OKMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Nov 14, 2022 Accepting new patients

Locations

700 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-3667

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Interoperability endpoints

  • Direct secure messaging: agomez530668@direct.integrisok.com

Organizations & group practices 6

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 4

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": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1659095594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 NE 2ND ST APT 311",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731042264",
            "telephone_number": "575-390-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 13TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045004",
            "telephone_number": "405-271-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "ANDRE",
        "middle_name": "JAYLAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "4953",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "4953",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OK",
            "license": "PA4953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.