Active NPI
Rommel B Gayagoy, FNP
- Nurse Practitioner
- Clearlake, CA
National Provider Identifier
1780140046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95010310
- Practice address
- 15230 Lakeshore Dr
Clearlake, CA 95422-8107 - Phone
- (707) 995-4500
- NPI assigned
- Feb 12, 2019
- Last updated
- Feb 12, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95010310 | CA | Primary |
Addresses
Primary practice location
15230 Lakeshore Dr
Clearlake, CA 95422-8107
Mailing address
10140 Tank House Dr
Stockton, CA 95209-4335
Phone (209) 598-6590
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221221002007 | CA | Order and Referring Only - Nurse Practitioner | 9739422825 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- rommel.gayagoy.1@33563.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1780140046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10140 TANK HOUSE DR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952094335",
"telephone_number": "209-598-6590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15230 LAKESHORE DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954228107",
"telephone_number": "707-995-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAYAGOY",
"first_name": "ROMMEL",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-12",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95010310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; 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.