NPIMap

Individual provider Active NPI

Rebecca D Goranson, PA-C

  • Surgical Physician Assistant
  • Durango, CO
National Provider Identifier
1790025443
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.0005954 Issued in CO
Practice address
1 Mercado St Ste 202
Durango, CO 81301-7307
Phone
(970) 764-9400
Fax
(970) 764-9449
NPI assigned
Feb 18, 2013
Last updated
May 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X SC
Surgical Physician Assistant 363AS0400X 1902 SC
Surgical Physician Assistant 363AS0400X PA.0005954 CO Primary

Addresses

Primary practice location

1 Mercado St Ste 202
Durango, CO 81301-7307

Mailing address

PO Box 800022
Kansas City, MO 64180-0022

Other practice location 1

104 Saluda Pointe Dr
Lexington, SC 29072-7295
Phone (803) 227-9178

Other practice location 2

102 Gregor Mendel Cir
Greenwood, SC 29646-2315
Phone (864) 229-2663

Other names 1

  • Rebecca A Daubert Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, CO2 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
I20130416000172 SC Practitioner - Physician Assistant 5193961282 Reassigns benefits to 2 organizations
I20191004002042 CO Practitioner - Physician Assistant 5193961282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

1 Mercado St
Suite 202
Durango, CO 81301-7307
Phone (970) 764-9400

1010 Three Springs Blvd
Durango, CO 81301-8296

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0005954COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Feb 1, 2018 Accepting new patients
Self Medical Group CurrentSince Mar 4, 2019 Accepting new patients
Self Medical Group CurrentSince Mar 4, 2019 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Feb 1, 2018 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Sep 30, 2019 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Sep 30, 2019 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients
Palmetto Health Past Accepting new patients

Locations

1 Mercado St
Ste 202
Durango, CO 81301
Phone (970) 247-5362

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

75 Remittance Dr
Dept 6764
Chicago, IL 60675

14 Richland Medical Park Dr
Ste 200
Columbia, SC 29203
Phone (803) 296-9200

102 Gregor Mendel Cir
Greenwood, SC 29646
Phone (864) 229-2663

104 Saluda Pointe Dr
Lexington, SC 29072
Phone (803) 296-9200

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Organizations & group practices 11

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.

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": "1361145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1790025443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800022",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641800022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST STE 202",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017307",
            "telephone_number": "970-764-9400",
            "fax_number": "970-764-9449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Saluda Pointe Dr",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "SC",
            "postal_code": "290727295",
            "country_code": "US",
            "telephone_number": "803-227-9178",
            "fax_number": "803-227-8278",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "102 Gregor Mendel Cir",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296462315",
            "country_code": "US",
            "telephone_number": "864-229-2663",
            "fax_number": "864-223-5694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORANSON",
        "first_name": "REBECCA",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-18",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "1902",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0005954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "DAUBERT",
            "middle_name": "A",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.