Active NPI
Stasha C Gominak, MD
- Neurology Physician
- Tyler, TX
National Provider Identifier
1659486116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- G5098
- Practice address
- 700 Olympic Plaza Cir
Ste 912
Tyler, TX 75701-1951 - Phone
- (903) 596-3808
- Fax
- (903) 596-3815
- NPI assigned
- Aug 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | G5098 | TX | Primary |
Addresses
Primary practice location
700 Olympic Plaza Cir
Ste 912
Tyler, TX 75701-1951
Mailing address
700 Olympic Plaza Cir
Ste 912
Tyler, TX 75701-1951
Phone (903) 596-3808
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164215901 | Medicaid | TX | |
| 8K7990 | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G5098 | TX | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248912000000",
"number": "1659486116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 OLYMPIC PLAZA CIR",
"address_2": "STE 912",
"city": "TYLER",
"state": "TX",
"postal_code": "757011951",
"telephone_number": "903-596-3808",
"fax_number": "903-596-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 OLYMPIC PLAZA CIR",
"address_2": "STE 912",
"city": "TYLER",
"state": "TX",
"postal_code": "757011951",
"telephone_number": "903-596-3808",
"fax_number": "903-596-3815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMINAK",
"first_name": "STASHA",
"middle_name": "C",
"name_prefix": "Ms.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2009-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "G5098",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164215901",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8K7990",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.