Kevin Gonzalez

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62412 Issued in CA

Practice address

1180 N Indian Canyon Dr Ste E315
Palm Springs, CA 92262-4809

Phone

(760) 832-6277

NPI assigned

Mar 5, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Dermatology InstituteGroup PAC ID 2062546260, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Pacific Dermatology Institute

  • Dermatology Physician
  • Corona, CA
  • NPI 1740410182
  Medicare reassignment Care Compare group
• Advanced Dermatology & Cosmetics Laser Care a Medical Corporation

  • Specialist
  • Valencia, CA
  • NPI 1912026097

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1646438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1790432110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31938 S. TEMECULA PARKWAY, SUITE #A337",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925926810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N INDIAN CANYON DR STE E315",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624809",
            "telephone_number": "760-832-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-05",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tatiana Gomez, MD
• Charles David Gonzales, M.D.
• Jennifer Marie Gonzales, NP
• Amber Gonzalez
• Gabriel Ray Gonzalez
• Melvin A. Gonzalez, MD
• Mireya I Gonzalez Jr., LMFT
• Hayden Gorham
• Ewa Gosek, M.D.,
• Rory Dennis Goshorn, MFT PSYD

• Physician Assistant in Palm Springs, CA
• Providers in Palm Springs, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.