Gavelyn Poonnopatam, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

010273 Issued in AZ

Practice address

155 Calle Portal
Sierra Vista, AZ 85635-2900

Phone

(520) 364-1429

NPI assigned

Apr 15, 2020

Last updated

Aug 11, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Family Practice

Education

Western Un of HLTH Sciences, Col of Podiatric Med, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chiricahua Community Health Centers IncGroup PAC ID 5395638878, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bayada Home Health Care, Inc Home health agency, Sierra Vista, AZ, CCN 037416
• Canyon Vista Medical Center Hospital, Sierra Vista, AZ, CCN 030043

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gavelyn.poonnopatam.p1@direct.cchci.nextgenshare.com

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.

• Chiricahua Community Health Centers, Inc

  dba Business Office

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1942241443
  Medicare reassignment Care Compare group NPD
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1801821970
  NPD
• Chiricahua Community Health Centers, Inc.

  dba Willcox Clinic

  • Federally Qualified Health Center (FQHC)
  • Willcox, AZ
  • NPI 1285488866
  NPD
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1174820898
  NPD (past)

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

• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Sierra Vista, AZ
  • NPI 1912291139
  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Sonoita Family Health

  • Rural Health Clinic/Center
  • Sonoita, AZ
  • NPI 1013160290

  Hospital

  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Canyon Vista Medical Center

  • General Acute Care Hospital
  • Sierra Vista, AZ
  • NPI 1194766543
  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Tombstone Family Health

  • Rural Health Clinic/Center
  • Tombstone, AZ
  • NPI 1508010471

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1962021378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900",
            "telephone_number": "520-364-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900",
            "telephone_number": "520-364-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POONNOPATAM",
        "first_name": "GAVELYN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "010273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina M. Pitts, LCSW
• Timothy Alan Platt, LPC
• Lucie Pohronova
• Lindsey Ann Polcari
• Ange Marie Pompee-Synsmir, ARNP
• Tracy Post, PHARM.D.
• Maureen Kathryn Potucek
• April Michelle Power, DNP
• Frederick Eugene Powers Jr., FNP-BC
• Corey Poynor-Dunning

• Family Medicine Physician in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.