Individual provider Active NPI

Gerald E Gonnella, P.A.

  • Surgical Physician Assistant
  • Chesterton, IN
National Provider Identifier
1801894407
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10000264A Issued in IN
Practice address
601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone
(219) 921-1444
Fax
(219) 921-5303
NPI assigned
Jul 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10000264A IN Primary

Addresses

Primary practice location

601 Gateway Blvd N
Chesterton, IN 46304-9658

Mailing address

601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444

Other practice location 1

3691 Willowcreek Rd
Portage, IN 46368-5080
Phone (219) 921-1444

Other practice location 2

500 E 109th Ave
Crown Point, IN 46307
Phone (219) 921-1444

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address g.gonnella@lbji.exscribedirect.com Direct
Direct Messaging Address g.gonnella@lbji.exscribedirect.com Direct
Direct Messaging Address g.gonnella@lbji.exscribedirect.com Direct

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100803000802 IN Practitioner - Physician Assistant 3173506110 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Bone and Joint Institute II, LLCGroup PAC ID 0446512909, 8 clinicians

Practice addresses (Care Compare)

601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.62 of 100Reported as group
Quality
100
Improvement activities
40
Cost
75.38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10000264AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Bone & Joint Institute, PC Current Accepting new patients
Lakeshore Bone & Joint Institute, PC CurrentSince May 4, 2003 Accepting new patients

Locations

601 Gateway Blvd N
Chesterton, IN 46304
Phone (219) 921-1401

500 E 109th Ave
Crown Point, IN 46307

3691 Willowcreek Rd
Portage, IN 46368
Phone (219) 759-4380

Interoperability endpoints

  • Direct secure messaging: ggonnella83100@direct.franciscanalliance.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1801894407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3691 Willowcreek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685080",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 E 109th Ave",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "46307",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONNELLA",
        "first_name": "GERALD",
        "middle_name": "E",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10000264A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "g.gonnella@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3691 Willowcreek Rd",
            "city": "Portage",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463685080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "g.gonnella@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "601 Gateway Blvd N",
            "city": "Chesterton",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463049658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "g.gonnella@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 E 109th Ave",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chesterton, IN

Sources for this page

Verify at the official NPI Registry.