Individual provider Active NPI

Pamela S Gjertson, AUD., CCC-A

  • Audiologist
  • Burleson, TX
National Provider Identifier
1659328128
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
12001 South Fwy Ste 209
Burleson, TX 76028-7214
Phone
(823) 857-0106
Fax
(682) 385-7011
NPI assigned
May 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X DA8540 AZ
Audiologist 231H00000X Primary

Addresses

Primary practice location

12001 South Fwy Ste 209
Burleson, TX 76028-7214

Mailing address

12001 South Fwy Ste 209
Burleson, TX 76028-7214
Phone (682) 385-7010

Other practice location 1

2302 Lone Star Rd Ste 220
Mansfield, TX 76063-8752
Phone (682) 341-7220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150226000403 TX Practitioner - Qualified Audiologist 4284732389 Reassigns benefits to 3 organizations
I20180309001836 AK Practitioner - Qualified Audiologist 4284732389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

4450 Sunset Dr
San Angelo, TX 76904
Phone (325) 747-1511

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DA8540AZMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic CurrentSince Jun 1, 2024 Accepting new patients
Northern Hearing Services Incorporated Audiologist CurrentSince Feb 1, 2018 Accepting new patients
Tanana Chiefs Conference CurrentSince Jan 1, 2016 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Jan 20, 2015 Accepting new patients
Tanana Chiefs Conference CurrentSince Jan 1, 2016 Accepting new patients

Locations

4200 Lake Otis Pkwy
Ste 302
Anchorage, AK 99508
Phone (907) 561-1326

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

3801 University Lake Dr
Anchorage, AK 99508
Phone (907) 563-8876

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

4450 Sunset Dr
San Angelo, TX 76901
Phone (325) 481-2286

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1659328128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12001 SOUTH FWY STE 209",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287214",
            "telephone_number": "682-385-7010",
            "fax_number": "682-385-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12001 SOUTH FWY STE 209",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287214",
            "telephone_number": "823-857-0106",
            "fax_number": "682-385-7011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2302 Lone Star Rd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "TX",
            "postal_code": "760638752",
            "country_code": "US",
            "telephone_number": "682-341-7220",
            "fax_number": "682-341-7222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GJERTSON",
        "first_name": "PAMELA",
        "middle_name": "S",
        "credential": "AUD., CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "AZ",
            "license": "DA8540",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burleson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.