Gabrielle Elizabeth Maxwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

OA005914 Issued in PA

Practice address

100 Schuylkill Medical PLZ Ste 105
Pottsville, PA 17901-3636

Phone

(570) 622-4840

Fax

(570) 622-7589

NPI assigned

Feb 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Gabrielle Elizabeth Evans Former name

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gevans@imgpc.medentdirect.com

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.

• Integrated Medical Group P C

  • Family Medicine Physician
  • Pottsville, PA
  • NPI 1336102268

  PA

  Medicare reassignment
• Integrated Medical Group, P.C.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Reading, PA
  • NPI 1881341303
  NPD

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1669065744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SCHUYLKILL MEDICAL PLZ STE 105",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013636",
            "telephone_number": "570-624-4840",
            "fax_number": "570-622-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SCHUYLKILL MEDICAL PLZ STE 105",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013636",
            "telephone_number": "570-622-4840",
            "fax_number": "570-622-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "GABRIELLE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062925",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA005914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GABRIELLE",
            "last_name": "EVANS",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lindsey Martinez, MD
• Maternal & Family Health Services, Inc.
• Glady Mary Mathew, MD
• Zachary Matuzsan, DO
• Joseph Matz, M.D.
• Mallory McBreen, COTA
• Angela Ann McCabe, OTRL
• Kathy E McCaw, MA
• Sue Lynn McCormick, CRNP
• Leeann McDermott, CRNP

• All providers in Pottsville, PA
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.