Gary R Gibson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35048883 Issued in OH

Practice address

310 Windsor Dr
Cortland, OH 44410-2705

Phone

(330) 637-0356

Fax

(330) 637-0361

NPI assigned

Jul 18, 2005

Reactivated

Apr 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Steward Medical Group Inc.

  • Internal Medicine Physician
  • Brookfield, OH
  • NPI 1902347438

  Internal Medicine, OH

  Medicare reassignment NPD
• Steward Medical Group, Inc

  • Specialist
  • Brighton, MA
  • NPI 1356654495
  NPD

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1821097486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 WINDSOR DR",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444102705",
            "telephone_number": "330-637-0356",
            "fax_number": "330-637-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 WINDSOR DR",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444102705",
            "telephone_number": "330-637-0356",
            "fax_number": "330-637-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "GARY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2011-01-06",
        "deactivation_date": "2006-03-18",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35048883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4122159",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000147036",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0631865",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fresenius Medical Care Youngstown, LLC
• De Anna Nichole Fuchilla
• Alyssa Lynn Furey, D.D.S.
• Alwyn Baltazar Galela, BSN-RN
• Benjamin Galela, BA
• Golden Age Mobility
• Paul N Gould, M.D.
• Gregory Davenport DDS & John Rohrabaugh DDS Inc
• Thomas R Groner, MD
• Jamie Lee Gunia, PT

• All providers in Cortland, OH
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.