NPIMap

Individual provider Active NPI

Yuebo Gan, M.D., PH.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Vineland, NJ
National Provider Identifier
1972769768
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
25MA9045700 Issued in NJ
Practice address
1505 W Sherman Avenue
Vineland, NJ 08360-7059
Phone
(856) 690-1305
NPI assigned
Aug 1, 2008
Last updated
Dec 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X MT 189556 PA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MA9045700 NJ Primary

Addresses

Primary practice location

1505 W Sherman Avenue
Vineland, NJ 08360-7059

Mailing address

1138 E Chestnut Avenue
7C
Vineland, NJ 08360-5053
Phone (215) 762-7179

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120607000259 NJ Practitioner - Pathology 5698939411 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garden State Physician Associates LLCGroup PAC ID 9931561131, 5 clinicians

Practice addresses (Care Compare)

1505 W Sherman Ave
Vineland, NJ 08360-7059
Phone (856) 641-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.47 of 100Reported as group
Quality
77.82
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA9045700NJMDAnatomic Pathology & Clinical Pathology Physician
MT 189556PAMDGeneral Acute Care Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
Garden State Physician Associates LLC Anatomic Pathology & Clinical Pathology CurrentSince Aug 4, 2023 Accepting new patients
Southern Regional Pathology Associates, PC CurrentSince Jul 1, 2012 Accepting new patients

Locations

1138 E Chestnut Ave
Ste 7C
Vineland, NJ 08360

1505 W Sherman Ave
Vineland, NJ 08360
Phone (856) 451-6600

5700 Southwyck Blvd
Toledo, OH 43614

Organizations & group practices 2

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.

Hospital & facility affiliations 6

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": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1972769768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 E CHESTNUT AVENUE",
            "address_2": "7C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605053",
            "telephone_number": "215-762-7179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVENUE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607059",
            "telephone_number": "856-690-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAN",
        "first_name": "YUEBO",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "MT 189556",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA9045700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.