NPIMap

Individual provider Active NPI

Courtney Gough, PA-C

  • Medical Physician Assistant
  • Brick, NJ
National Provider Identifier
1982434171
Registry record updated Aug 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
25MP00873400 Issued in NJ
Practice address
495 Jack Martin Blvd Ste 2
Brick, NJ 08724-7778
Phone
(732) 458-7575
NPI assigned
Aug 3, 2024
Last updated
Aug 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 25MP00873400 NJ Primary

Addresses

Primary practice location

495 Jack Martin Blvd Ste 2
Brick, NJ 08724-7778

Mailing address

46 Castle Ave
Jackson, NJ 08527-2513
Phone (732) 856-3558

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
I20240919002300 NJ Practitioner - Physician Assistant 6800337668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiology Associates of Ocean CountyGroup PAC ID 7810886389, 5 clinicians

Practice addresses (Care Compare)

27 S Cooks Bridge Rd
Suite 210
Jackson, NJ 08527-2524
Phone (732) 987-5690

495 Jack Martin Blvd
Suite 2
Brick, NJ 08724-7778
Phone (732) 458-7575

Hospital & facility affiliations

National Provider Directory

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

Organizations & group practices 1

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 8

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": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1982434171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 CASTLE AVE",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085272513",
            "telephone_number": "732-856-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 JACK MARTIN BLVD STE 2",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247778",
            "telephone_number": "732-458-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "COURTNEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00873400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

Verify at the official NPI Registry.