Individual provider Active NPI

Rose E. Gonzalez, PH.D.

  • Developmental - Behavioral Pediatrics Physician
  • Charlottesville, VA
National Provider Identifier
1710143789
Registry record updated Aug 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
0810000348 Issued in VA
Practice address
1204 W Main St
Charlottesville, VA 22903-2824
Phone
(434) 924-0123
Fax
(434) 243-3300
NPI assigned
Jul 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X 0810000348 VA Primary
Clinical Psychologist 103TC0700X 0810000348 VA

Addresses

Primary practice location

1204 W Main St
Charlottesville, VA 22903-2824

Mailing address

PO Box 9007
Charlottesville, VA 22906-9007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151006001368 VA Practitioner - Clinical Psychologist 6709194046 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0810000348VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Virginia Physicians Group CurrentSince Jul 27, 2015 Accepting new patients

Locations

1204 W Main St
Charlottesville, VA 22903
Phone (434) 924-0123

1215 Lee St
Fl 8
Charlottesvle, VA 22908
Phone (434) 924-2500

Interoperability endpoints

  • Direct secure messaging: rgonzalez286108@direct.healthsystem.virginia.edu

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1217376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1710143789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229069007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 W MAIN ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229032824",
            "telephone_number": "434-924-0123",
            "fax_number": "434-243-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "ROSE",
        "middle_name": "E.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-30",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "VA",
            "license": "0810000348",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810000348",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.