NPIMap

Individual provider Active NPI

Victor Gomez

  • Durable Medical Equipment & Medical Supplies
  • El Paso, TX
National Provider Identifier
1689931032
Registry record updated Oct 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
0055163 Issued in TX
Practice address
11601 Pellicano Dr
Suite B8
El Paso, TX 79936-6279
Phone
(915) 593-3556
Fax
(915) 595-6556
NPI assigned
Apr 23, 2012
Last updated
Oct 26, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 0055163 TX Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 0055163 TX
Oxygen Equipment & Supplies (DME) 332BX2000X 0055163 TX

Addresses

Primary practice location

11601 Pellicano Dr
Suite B8
El Paso, TX 79936-6279

Mailing address

11601 Pellicano Dr
Suite B8
El Paso, TX 79936-6279
Phone (915) 593-3556

Other identifiers 4

IdentifierTypeStateIssuer
531034OtherBLUE CROSS BLUE SHIELD TX
144538901MedicaidTX
144537101MedicaidTX
QMP000003931980OtherTXMOLINA HEALTH CARE

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0055163TXMDParenteral & Enteral Nutrition Supplies (DME)

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351209600000",
    "number": "1689931032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 PELLICANO DR",
            "address_2": "SUITE B8",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366279",
            "telephone_number": "915-593-3556",
            "fax_number": "915-595-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 PELLICANO DR",
            "address_2": "SUITE B8",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366279",
            "telephone_number": "915-593-3556",
            "fax_number": "915-595-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "VICTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0055163",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "0055163",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "TX",
            "license": "0055163",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TX",
            "identifier": "531034",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144538901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144537101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTH CARE",
            "identifier": "QMP000003931980",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.