NPIMap

Individual provider Active NPI

Krista R. Gorman, PA-C

  • Physician Assistant
  • Wailuku, HI
National Provider Identifier
1922167550
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
AMD-1025 Issued in HI
Practice address
55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone
(808) 243-6050
NPI assigned
Dec 8, 2006
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X AMD-1025 HI Primary
Physician Assistant 363A00000X PA9101480 FL

Addresses

Primary practice location

55 Maui Lani Pkwy
Wailuku, HI 96793-2416

Mailing address

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, HI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101108001092 FL Practitioner - Physician Assistant 9436344157 Reassigns benefits to 3 organizations
I20220318001711 HI Practitioner - Physician Assistant 9436344157 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9101480FLMDPhysician Assistant
AMD-1025HIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Adventist Health System/Sunbelt Inc. Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Urgent Care Centers of Brevard County LLC Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Restore Medical Partners, PLLC CurrentSince May 1, 2019 Accepting new patients
Punta Gorda Hma Physician Management LLC Past Accepting new patients
Genesiscare USA of Florida LLC Past Accepting new patients
Punta Gorda Hma Physician Management LLC PastSince Jul 1, 2007 Accepting new patients

Locations

440 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 788-2000

105 S Banana River Blvd
Cocoa Beach, FL 32931
Phone (321) 783-3362

2600 Westhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 200-1353

333 Tamiami Trl S
Ste 169171
Venice, FL 34285
Phone (941) 375-3006

Interoperability endpoints

  • Direct secure messaging: krista.gorman.1@17280.direct.athenahealth.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1922167550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "KRISTA",
        "middle_name": "R.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD-1025",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101480",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "55 Maui Lani Pkwy",
            "city": "Wailuku",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967932416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.