Michael T. Gambla, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

35073770 Issued in OH

Practice address

350 W Wilson Bridge Rd Ste 100
Worthington, OH 43085-2590

Phone

(614) 796-2900

Fax

(614) 796-2901

NPI assigned

Apr 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Urology

Education

Rush Medical College of Rush University, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mgambla31776@direct.riversidehealthcare.net

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.

• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment Care Compare group NPD
• Riverside Health System

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1952367641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TECH CENTER DR STE 250",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432301987",
            "telephone_number": "614-944-4800",
            "fax_number": "614-944-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WILSON BRIDGE RD STE 100",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430852590",
            "telephone_number": "614-796-2900",
            "fax_number": "614-796-2901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Tech Center Dr",
            "address_purpose": "LOCATION",
            "city": "Gahanna",
            "state": "OH",
            "postal_code": "432301987",
            "country_code": "US",
            "telephone_number": "614-396-2684",
            "fax_number": "614-396-2480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAMBLA",
        "first_name": "MICHAEL",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-22",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35073770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2242755",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jazmin Gaither, LMT
• Kellen Jena Gaither
• Warren Nikolaus Gall, D.D.S.
• Jennifer Ann Gallaway
• Michelle Frances Galloway, APRN-CNP
• Jillian Gamble
• Jennifer Gannon
• Tracy C Gantt, PHARMD
• Xu Guang Gao
• Jennifer Garbin, MSW, LSW

• Urology Physician in Worthington, OH
• Providers in Worthington, OH by specialty
• Urology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.