NPIMap

Individual provider Active NPI

John M Gibson, M.D

  • Emergency Medicine Physician
  • Longview, WA
National Provider Identifier
1720288681
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD183368 Issued in OR
Practice address
1615 Delaware St
Longview, WA 98632-2310
Phone
(360) 414-2000
NPI assigned
Jul 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD00047671 WA
Emergency Medicine Physician 207P00000X MD183368 OR Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2310

Mailing address

PO Box 11510
Westminster, CA 92685-1510
Phone (866) 883-5375

Other identifiers 2

IdentifierTypeStateIssuer
8489247MedicaidWA
274621MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131121000272 ID Practitioner - Emergency Medicine 6608960067 Reassigns benefits to 2 organizations
I20171114002585 OR Practitioner - Emergency Medicine 6608960067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Temple University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

351 SW 9TH St
Ontario, OR 97914-2639
Phone (541) 881-7000

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD183368ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Walter Knox Memorial Hospital Current Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Cep America, LLC Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

1202 E Locust St
Emmett, ID 83617
Phone (208) 365-2338

4300 E Flamingo Ave
Nampa, ID 83687
Phone (208) 205-1000

351 SW 9th St
Ontario, OR 97914
Phone (541) 881-7000

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/eb237299-e2be-4fd4-aca6-5fa7adcd28c1/
  • Direct secure messaging: jgibson74628@direct.peacehealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1720288681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11510",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926851510",
            "telephone_number": "866-883-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322310",
            "telephone_number": "360-414-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00047671",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD183368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8489247",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274621",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.