Theresa Sullivan Gonzales, DMD, MS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

2648 Issued in SC

Practice address

173 Ashley Avenue MSC 507
Charleston, SC 29401

Phone

(843) 792-8723

Fax

(843) 792-3697

NPI assigned

Apr 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

79.02 of 100Reported as group

Quality

62.41

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tgonzales35822@direct.musc.edu

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.

• University Medical Associates of the Medical University of South Carol

  • Multi-Specialty Clinic/Center
  • Charleston, SC
  • NPI 1043241110
  Medicare reassignment NPD
• University Medical Associates of the Medical University of South Carol

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1982678496
  NPD
• Medical University of South Carolina

  • Clinical Medical Laboratory
  • Charleston, SC
  • NPI 1437636057
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1912969502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 ASHLEY AVENUE MSC 507",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29401",
            "telephone_number": "843-792-8723",
            "fax_number": "843-792-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "THERESA",
        "middle_name": "SULLIVAN",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "TX",
            "license": "17566",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "SC",
            "license": "2648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey M Goller, M.D.
• Alexander Valerikovich Golovlev, M.D.
• Mark Steven Golub
• Dierdre Gonnigan
• Tessa Simpson Gonyea, MSP, CCC-SLP
• Albert David Gonzalez
• Alexus Misiel Gonzalez, MD
• Ana Gonzalez
• David Pamintuan Gonzalez, NP-C
• Jenny Lynn Gonzalez

• Oral and Maxillofacial Pathology Dentistry in Charleston, SC
• Providers in Charleston, SC by specialty
• Oral and Maxillofacial Pathology Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.