Individual provider Active NPI

Roman R Gavino, MD

  • Pediatrics Physician
  • Kennewick, WA
National Provider Identifier
1922075597
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
052175 Issued in GA
Practice address
7211 W Deschutes Ave
Kennewick, WA 99336-7728
Phone
(509) 737-1880
Fax
(509) 737-1879
NPI assigned
Mar 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 052175 GA Primary

Addresses

Primary practice location

7211 W Deschutes Ave
Kennewick, WA 99336-7728

Mailing address

7211 W Deschutes Ave
Suite E
Kennewick, WA 99336-7728
Phone (509) 735-9239

Other identifiers 3

IdentifierTypeStateIssuer
000975939AMedicaidGA
000975939BMedicaidGA
1922075597MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
052175GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
RCCH Trios Health LLC Past Accepting new patients
Kennewick Public Hospital District Past Accepting new patients
Kennewick Public Hospital District Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: roman.gavino.1@18485.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1922075597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7211 W DESCHUTES AVE",
            "address_2": "SUITE E",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367728",
            "telephone_number": "509-735-9239",
            "fax_number": "509-735-9310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 W DESCHUTES AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367728",
            "telephone_number": "509-737-1880",
            "fax_number": "509-737-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVINO",
        "first_name": "ROMAN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "052175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000975939A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000975939B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922075597",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.