Individual provider Active NPI

Jeremy Brendon Gibson, D.O.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rochester, MN
National Provider Identifier
1912987504
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
55625 Issued in MN
Practice address
1650 4TH St SE
Rochester, MN 55904-4717
Phone
(507) 529-6616
Fax
(507) 529-6622
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 02007660A IN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X C3863 KY
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 55625 MN Primary

Addresses

Primary practice location

1650 4TH St SE
Rochester, MN 55904-4717

Mailing address

1650 4TH St SE
Rochester, MN 55904-4717
Phone (507) 529-6616

Other practice location 1

250 Park St
Bowling Green, KY 42101-1760
Phone (270) 745-1264

Other practice location 2

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 435-2856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IN, KY, TN, KS, TX6 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
I20250407001069 MO Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization
I20250905003012 IN Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization
I20250908002249 KY Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization
I20251020000227 TN Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization
I20260112003301 KS Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization
I20260417002283 TX Practitioner - Pathology 0042476905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Pathologists, LLCGroup PAC ID 0648167544, 137 clinicians

Practice addresses (Care Compare)

1010 Airpark Ctr Dr
Nashville, TN 37217-5200
Phone (615) 221-4400

250 Park St
Bowling Green, KY 42101-1760
Phone (270) 745-1000

401 Woodland Hills Blvd
Fort Scott, KS 66701-8797
Phone (417) 502-3840

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4160
Phone (615) 221-4447

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55625MNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Pathologists, LLC Anatomic Pathology & Clinical Pathology CurrentSince Jun 29, 2025 Accepting new patients
Citizens Memorial Hospital District CurrentSince Mar 1, 2025 Accepting new patients
Citizens Memorial Hospital District CurrentSince Mar 1, 2025 Accepting new patients
Associated Pathologists LLC Past Accepting new patients

Locations

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

401 Woodland Hills Blvd
Fort Scott, KS 66701
Phone (620) 223-2200

1201 E Centennial Dr
Pittsburg, KS 66762
Phone (620) 231-0204

1801 Ashley Cir
Bowling Green, KY 42104
Phone (270) 781-4330

250 Park St
Bowling Green, KY 42101
Phone (270) 745-1000

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

5301 Virginia Way
Ste 300
Brentwood, TN 37027
Phone (615) 695-4977

1010 Airpark Center Dr
Nashville, TN 37217
Phone (615) 221-4447

Organizations & group practices 5

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1912987504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6616",
            "fax_number": "507-529-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 4TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044717",
            "telephone_number": "507-529-6616",
            "fax_number": "507-529-6622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Park St",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421011760",
            "country_code": "US",
            "telephone_number": "270-745-1264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7950 W Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468044140",
            "country_code": "US",
            "telephone_number": "260-435-2856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JEREMY",
        "middle_name": "BRENDON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "02007660A",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "KY",
            "license": "C3863",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MN",
            "license": "55625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.