NPIMap

Individual provider Active NPI

Omar J Gonzalez, PA-C

  • Surgical Physician Assistant
  • Renton, WA
National Provider Identifier
1831412485
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60133734 Issued in WA
Practice address
4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773
Phone
(425) 656-5060
Fax
(425) 656-5047
NPI assigned
Mar 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60133734 WA
Surgical Physician Assistant 363AS0400X PA60133734 WA Primary

Addresses

Primary practice location

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773

Mailing address

9200 SE 91St Ave
Ste 340
Portland, OR 97086-3756
Phone (503) 256-1462

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100525000497 WA Practitioner - Physician Assistant 1355470634 Reassigns benefits to 1 organization
I20180921002304 OR Practitioner - Physician Assistant 1355470634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3909 9TH Ave SW
Olympia, WA 98502-5134
Phone (360) 570-3460

615 Lilly Rd NE
Olympia, WA 98506-5117
Phone (360) 491-4211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.86 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
87.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60133734WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Orthopaedic Associates, PLLC CurrentSince Jun 1, 2023 Accepting new patients
Olympia Orthopaedic Associates PLLC CurrentSince Jun 1, 2023 Accepting new patients

Locations

615 Lilly Rd NE
Ste 240
Olympia, WA 98506
Phone (360) 413-3850

3909 9th Ave SW
Olympia, WA 98502
Phone (360) 570-3460

404 Yauger Way SW
Ste 100
Olympia, WA 98502
Phone (360) 786-8990

Interoperability endpoints

  • Direct secure messaging: omar.gonzalez.1@5512.direct.athenahealth.com
  • Direct secure messaging: omar.gonzalez.p1@direct.kelloggbrainspine.nextgenshare.com
  • FHIR API: https://api.platform.athenahealth.com/5512/brand/1/csg/1/fhir/r4

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 8

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": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1831412485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 SE 91ST AVE",
            "address_2": "STE 340",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "970863756",
            "telephone_number": "503-256-1462",
            "fax_number": "503-257-9523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S",
            "address_2": "SUITE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555773",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "OMAR",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-10",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60133734",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60133734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.