Benjamin Jacob Gomez, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

2001 Victor Wharf
Pearl City, HI 96782

Phone

(954) 614-7005

NPI assigned

Sep 5, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1801445663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 VICTOR WHARF",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "96782",
            "telephone_number": "954-614-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VICTOR WHARF",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "96782",
            "telephone_number": "954-614-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "BENJAMIN",
        "middle_name": "JACOB",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-05",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1102X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military Outpatient Operational (Transportable) Component",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1103X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military Ambulatory Procedure Visits Operational (Transportable)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOD ID",
            "identifier": "1384550807",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "app.tolsecuremessaging.com",
            "affiliation": "N",
            "endpointDescription": "TOL Secure Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "TOL Secure Messaging",
            "address_1": "2001 Victor Wharf",
            "city": "Pearl City",
            "state": "HI",
            "country_code": "US",
            "postal_code": "96782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charnay Shemesa Gima, LMHC, NCC
• Bernard Wilbur Giorgio, M.D.
• Glenn M. Okihiro, D.D.S., Inc.
• Joshua Matthew Godsey, IDC
• Francis Keliinani Gomes, ATC
• Scott Joseph Gomez, D.D.S.
• Samantha Gonzalez, PHARM D
• Erika Gutierrez
• Jennifer Haldane
• Glenn Hanada, DMD

• Independent Duty Corpsman in Pearl City, HI
• Providers in Pearl City, HI by specialty
• Independent Duty Corpsman in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.