Organization Active NPI

Elena Gurova, MD PA

  • Internal Medicine Physician
  • Cleburne, TX
National Provider Identifier
1790862316
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L7404 Issued in TX
Legal business name
ELENA GUROVA, MD PA
Practice address
519 N Main St
Cleburne, TX 76033-3845
Phone
(817) 645-5915
Fax
(817) 645-5935
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

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

Authorized official

Name
Dr. Elena Gurova, MDNPI 1023002144
Title
President and Secretaly
Phone
(817) 645-5915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X L7404 TX Primary

Addresses

Primary practice location

519 N Main St
Cleburne, TX 76033-3845

Mailing address

PO Box 770
Cleburne, TX 76033-0770
Phone (817) 645-5915

Other identifiers 1

IdentifierTypeStateIssuer
183757701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061121000338 TX Part B Supplier - Clinic/Group Practice 3476551771 Receives reassigned benefits from 1 practitioner
Practice locations: Cleburne, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1056377Elena Gurova, MD PA519 N Main Street, Cleburne, TX 76033Certificate of waiverJul 13, 2028

National Provider Directory

National Provider Directory

Locations

624 N Main St
Cleburne, TX 76033
Phone (817) 798-1386

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1790862316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760330770",
            "telephone_number": "817-645-5915",
            "fax_number": "817-645-5935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 N MAIN ST",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760333845",
            "telephone_number": "817-645-5915",
            "fax_number": "817-645-5935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELENA GUROVA, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "GUROVA",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "PRESIDENT AND SECRETALY",
        "authorized_official_telephone_number": "817-645-5915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L7404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183757701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleburne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.