Individual provider Active NPI

Gabrielle Lauren Lasala, PA-C

  • Physician Assistant
  • Dayton, OH
National Provider Identifier
1871178194
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.007182RX Issued in OH
Practice address
425 W Grand Ave Ste 1003
Dayton, OH 45405-4776
Phone
(937) 643-9299
NPI assigned
Mar 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 50.007182RX OH Primary

Addresses

Primary practice location

425 W Grand Ave Ste 1003
Dayton, OH 45405-4776

Mailing address

6967 Man O War LN
Mason, OH 45040-3448
Phone (513) 722-5945

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address glasala777112@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211112000780 OH Practitioner - Physician Assistant 8325437304 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8646

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.8 of 100Reported as group
Quality
73.21
Promoting interoperability
100
Improvement activities
40
Cost
76.12

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.007182RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Nov 30, 2021 Accepting new patients
Alliance Physicians Inc CurrentSince Nov 30, 2021 Accepting new patients

Locations

3535 Pentagon Blvd
Ste 320
Beavercreek, OH 45431
Phone (937) 490-2270

425 W Grand Ave
Ste 1003
Dayton, OH 45405
Phone (937) 226-7898

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

3700 Southern Blvd
Ste 300
Kettering, OH 45429
Phone (937) 395-8002

3533 Southern Blvd
Ste 5350
Kettering, OH 45429
Phone 9376439299 ext. 93764

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

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 5

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": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1871178194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6967 MAN O WAR LN",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450403448",
            "telephone_number": "513-722-5945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W GRAND AVE STE 1003",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454054776",
            "telephone_number": "937-643-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASALA",
        "first_name": "GABRIELLE",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-17",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007182RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "425 W Grand Ave Ste 1003",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454054776",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glasala777112@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "425 W Grand Ave Ste 1003",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454054776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.