NPIMap

Individual provider Active NPI

Mark Edward Gonsky, DO

  • Family Medicine Physician
  • Bend, OR
National Provider Identifier
1841464203
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO155003 Issued in OR
Practice address
1345 NW Wall St
Suite 302
Bend, OR 97703-1970
Phone
(541) 323-3960
Fax
(541) 323-3961
NPI assigned
Apr 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO155003 OR Primary

Addresses

Primary practice location

1345 NW Wall St
Suite 302
Bend, OR 97703-1970

Mailing address

1345 NW Wall St
Suite 302
Bend, OR 97703-1970
Phone (541) 323-3960

Other identifiers 2

IdentifierTypeStateIssuer
500641003MedicaidOR
12271587OtherORCAQH ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120307000260 OR Practitioner - Family Practice 2466611629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1345 NW Wall St
Suite 302
Bend, OR 97703-1970
Phone (541) 323-3960

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Deschutes Family Care, LLC CurrentSince Sep 29, 2015 Accepting new patients

Locations

1345 NW Wall St
Ste 302
Bend, OR 97703
Phone (541) 323-3960

Interoperability endpoints

  • Direct secure messaging: mark.gonsky.1@17951.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/17951/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heart 'N Home Hospice and Palliative CareBend, OR, CCN 381539 Hospice Contracted Managing Employee Mar 1, 2024
Signature Healthcare at HomeBend, OR, CCN 381580 Hospice W-2 Managing Employee Dec 1, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 6

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": "1208304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1841464203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 NW WALL ST",
            "address_2": "SUITE 302",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977031970",
            "telephone_number": "541-323-3960",
            "fax_number": "541-323-3961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 NW WALL ST",
            "address_2": "SUITE 302",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977031970",
            "telephone_number": "541-323-3960",
            "fax_number": "541-323-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONSKY",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-16",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO155003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641003",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "12271587",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.