Gallus Lereh Fotabong

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AG11210066 Issued in MA

Practice address

41 Harvest St
Lynn, MA 01902-1122

Phone

(781) 244-8473

NPI assigned

Nov 17, 2021

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

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MA

  Medicare reassignment NPD
• Healthplus LLC

  • Urgent Care Clinic/Center
  • Middleton, MA
  • NPI 1821605502
  NPD

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

{
    "created_epoch": "1637107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1821755513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 HARVEST ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019021122",
            "telephone_number": "781-244-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 HARVEST ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019021122",
            "telephone_number": "781-244-8473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTABONG",
        "first_name": "GALLUS",
        "middle_name": "LEREH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-17",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "AG11210066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristiana M Forsyth, NP
• Briana Fortado, LCSW
• Marianne Fortier
• Chrystel D Fortunat
• Erica Rachel Foss, BA
• Anne Fournier, APRN-PMHNP
• Linda Jean Fowler, P.T.A.
• Aurora Estefani Francis, RN
• Jonangel Franco
• Judith Frank

• Gerontology Nurse Practitioner in Lynn, MA
• Providers in Lynn, MA by specialty
• Gerontology Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; 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.