Gina Rose Gastelum, P.A.C.
Individual provider Active NPI Physician Assistant · Fortuna, CA
NPI 1912946567 · NPPES record last updated Nov 2, 2021
Key facts
- NPI
- 1912946567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA15240 (CA)
- Practice address
- 3307 Renner Dr
Fortuna, CA 95540-3119 - Phone
- (707) 725-9832
- Fax
- (707) 725-7247
- NPI assigned
- Jun 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Washington School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence Medical Foundation
Practice addresses (Care Compare)
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210
2675 Harris St
Eureka, CA 95503-4806
Phone (707) 269-0644
2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121
2710 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 267-2060
500 Doyle Park Dr
Santa Rosa, CA 95405-4559
Hospital & facility affiliations
- Providence St Joseph Hospital
- Mad River Community Hospital
- Sutter Coast Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050120001031 | CA | Practitioner - Physician Assistant | 1153370739 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Six Rivers Emergency Physicians | Past | Accepting new patients | |
| Providence Medical Foundation | Past | Accepting new patients | |
| St. Joseph Health Northern California, LLC | Past | Accepting new patients |
Locations
200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841
2752 Harrison Ave
#A
Eureka, CA 95501
Phone (707) 268-0190
2675 Harris St
Eureka, CA 95503
Phone (707) 269-0644
2379 23rd St
Eureka, CA 95501
Phone (707) 443-9371
3307 Renner Dr
Fortuna, CA 95540
Phone (707) 725-6108
500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842
1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210
Interoperability endpoints
- ggastelum1657716@oc.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA15240 | CA | Yes |
Addresses
Primary practice location
3307 Renner Dr
Fortuna, CA 95540-3119
Mailing address
200 W Center Street Promenade Ste 300
Anaheim, CA 92805-3960
Phone (714) 449-4841
Other practice location 1
3800 Janes Rd
Arcata, CA 95521-4742
Phone (707) 826-8264
Other practice location 2
3800 Janes Rd
Arcata, CA 95521-4742
Phone (707) 826-8264
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA15240 | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ggastelum1657716@oc.providencedirect.org |
Other providers in Fortuna, CA
- Alan E French
- William M French
- Janna M Froeming
- Judy Gallagher
- Gardenside Eldercare, LLC
- Melanie Ror-Ree Gensaw
- Joyme Balan Gesite
- Chris Ghadimi
- Lexis D Gillette
- Kenneth Glenn
All providers in Fortuna, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.