NPIMap

Individual provider Active NPI

Rey S Gavino, M.D.

  • Internal Medicine Physician
  • Gadsden, AL
National Provider Identifier
1659457794
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25404 Issued in AL
Practice address
430 George Wallace Dr # 246
Gadsden, AL 35903-2280
Phone
(256) 343-1800
Fax
(256) 365-1046
NPI assigned
Oct 31, 2006
Last updated
Jul 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 25404 AL
Internal Medicine Physician 207R00000X 25404 AL Primary

Addresses

Primary practice location

430 George Wallace Dr # 246
Gadsden, AL 35903-2280

Mailing address

PO Box 550
Jacksonville, AL 36265-0550
Phone (256) 435-5499

Other identifiers 2

IdentifierTypeStateIssuer
009933285MedicaidAL
P00190295OtherALRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20051025000537 AL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 1052360708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

430 George Wallace Dr
Suite 246
Gadsden, AL 35903-2280
Phone (256) 343-1800

801 Goodyear Ave
Gadsden, AL 35903-1133
Phone (256) 365-1046

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue232

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25404ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jacksonville Internal Medicine Internal Medicine CurrentSince Jul 31, 2023 Accepting new patients
Rey Gavino MD PC Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Jacksonville Internal Medicine Internal Medicine CurrentSince Sep 2, 2003 Accepting new patients
QHG of Jacksonville Inc Internal Medicine Past Accepting new patients

Locations

430 George Wallace Dr
#246
Gadsden, AL 35903
Phone (256) 343-1800

801 Goodyear Ave
Gadsden, AL 35903
Phone (256) 439-5000

1465 1st Ave SW
Ste B
Jacksonville, AL 36265
Phone (205) 435-5499

2270 Pelham Rd S
Jacksonville, AL 36265
Phone (256) 435-5499

Organizations & group practices 4

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 6

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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1659457794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362650550",
            "telephone_number": "256-435-5499",
            "fax_number": "256-435-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 GEORGE WALLACE DR # 246",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359032280",
            "telephone_number": "256-343-1800",
            "fax_number": "256-365-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVINO",
        "first_name": "REY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AL",
            "license": "25404",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "25404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009933285",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00190295",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

Verify at the official NPI Registry.