NPIMap

Individual provider Active NPI

Paul Alan Gonzales, M.D.

  • Hematology & Oncology Physician
  • Jbsa Ft Sam Houston, TX
National Provider Identifier
1770962888
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
0101261696 Issued in VA
Practice address
3551 Roger Brooke Dr
McHe-QD (Creds)
Jbsa Ft Sam Houston, TX 78234
Phone
(210) 916-2460
NPI assigned
May 21, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101261696 VA
General Practice Physician 208D00000X 0101261696 VA
Hematology & Oncology Physician 207RH0003X 0101261696 VA Primary

Addresses

Primary practice location

3551 Roger Brooke Dr
McHe-QD (Creds)
Jbsa Ft Sam Houston, TX 78234

Mailing address

3551 Roger Brooke Dr
McHe-QD (Creds)
Jbsa Ft Sam Houston, TX 78234-4504
Phone (210) 916-2460

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230721001823 MN Practitioner - Internal MedicinePractitioner - Hematology/Oncology 6406123066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hematology/Oncology
Education
University of Texas Medical School at Houston, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carris Health LLCGroup PAC ID 7012274228, 40 clinicians

Practice addresses (Care Compare)

301 Becker Ave SW
Willmar, MN 56201-3302
Phone (320) 235-4543

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Mar 8, 2022 Accepting new patients
Mercy Health System Corporation CurrentSince Mar 8, 2022 Accepting new patients
Carris Health LLC CurrentSince Jul 1, 2023 Accepting new patients
Mercy Health System Corporation Current Accepting new patients
Carris Health LLC Hematology & Oncology CurrentSince Jul 1, 2023 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

Interoperability endpoints

  • Direct secure messaging: pgonzales689812@direct.centracare.com

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 4

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": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1770962888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "address_2": "MCHE-QD (CREDS)",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "address_2": "MCHE-QD (CREDS)",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-916-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "PAUL",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101261696",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101261696",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "VA",
            "license": "0101261696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jbsa Ft Sam Houston, TX

Sources for this page

Verify at the official NPI Registry.