NPIMap

Individual provider Active NPI

Jacqueline Rubylee Gorzynski, MD

  • Family Medicine Physician
  • Shelton, WA
National Provider Identifier
1861073074
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61443622 Issued in WA
Practice address
1701 N 13TH St
Shelton, WA 98584-2077
Phone
(360) 426-2653
Fax
(888) 985-0681
NPI assigned
Apr 19, 2021
Last updated
Aug 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 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 MD61443622 WA Primary

Addresses

Primary practice location

1701 N 13TH St
Shelton, WA 98584-2077

Mailing address

PO Box 1668
Shelton, WA 98584-5001
Phone (604) 279-5493

Other names 1

  • Jacqueline Rubylee Vaughn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20240626001922 WA Practitioner - Family Practice 2567853088 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1701 N 13TH St
Shelton, WA 98584-2077
Phone (360) 426-2653

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 1 of Mason County Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Jul 1, 2024 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Jan 27, 2026 Accepting new patients

Locations

1701 N 13th St
Shelton, WA 98584
Phone (360) 426-2653

1710 N 13th Loop Rd
Shelton, WA 98584
Phone (360) 426-4142

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

Interoperability endpoints

  • Direct secure messaging: jgorzynski1204989@wm.providencedirect.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1861073074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "604-279-5493",
            "fax_number": "360-427-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 13TH ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842077",
            "telephone_number": "360-426-2653",
            "fax_number": "888-985-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORZYNSKI",
        "first_name": "JACQUELINE",
        "middle_name": "RUBYLEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-19",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61443622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "VAUGHN",
            "middle_name": "RUBYLEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.