Tim B Gannon, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2010-0058 Issued in NM

Practice address

649 Harkle Rd Ste E
Santa Fe, NM 87505-4765

Phone

(505) 955-9454

Fax

(505) 216-9067

NPI assigned

Sep 21, 2010

Last updated

Mar 26, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest Care CenterGroup PAC ID 8921043035, shared by 2 NPIs, 28 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus St Vincent Regional Medical Center Hospital, Santa Fe, NM, CCN 320002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Aspen Medical Group LLC

  • Urgent Care Clinic/Center
  • Santa Fe, NM
  • NPI 1740533967
  Medicare reassignment
• Southwest Care Center

  • Federally Qualified Health Center (FQHC)
  • Santa Fe, NM
  • NPI 1871602698
  Medicare reassignment
• Winslow Indian Health Care Center, Inc

  • Federal Public Health Clinic/Center
  • Winslow, AZ
  • NPI 1184729493

  TX

  Medicare reassignment
• Healthfront PC

  • Emergency Medicine Physician
  • Santa Fe, NM
  • NPI 1417901612
  NPD
• Dilkon Medical Center

  • Federal Public Health Clinic/Center
  • Dilkon, AZ
  • NPI 1306016126
  NPD
• Winslow Indian Health Care Center, Inc

  dba Winslow Indian Health Care Ambulance

  • Land Ambulance
  • Winslow, AZ
  • NPI 1477827368
  NPD
• Truecare LLC

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1407227002
  NPD (past)
• North Country Healthcare, Inc.

  dba Flagstaff Pediatric Care

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1669911764
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Vincent Hospital

  dba CHRISTUS St. Vincent Regional Medical Center

  • General Acute Care Hospital
  • Santa Fe, NM
  • NPI 1578587150
  Care Compare affiliation

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

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1780992024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6880",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875026880",
            "telephone_number": "505-955-9454",
            "fax_number": "505-216-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 HARKLE RD STE E",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054765",
            "telephone_number": "505-955-9454",
            "fax_number": "505-216-9067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "TIM",
        "middle_name": "B",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-21",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2010-0058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25773119",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mamie Galston, LMT
• Ronnie Galvez
• Paige Alycia Gamache
• Joyce Gamble
• Marianne Gamble
• Karen Gano, LCSW
• Sarah Gano
• Rafael Gerardo Garabis, M.D.
• Markus E Garard, MD
• Cesar Alejandro Garay Jr., PHARMD

• Medical Physician Assistant in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Medical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.