| John Gambino, MD | |
|
2275 Laurel Dr, Ontario, OR 97914-4107 | |
| (952) 595-1100 | |
| (612) 294-4903 |
| Full Name | John Gambino |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 44 Years |
| Location | 2275 Laurel Dr, Ontario, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093773533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | MD19739 (Oregon) | Primary |
| 2085R0202X | Radiology - Diagnostic Radiology | 042-0012331 (Vermont) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Boise Advanced Imaging Pllc | 1850346180 | 2 |
| Teton Radiology Caldwell | 2365892742 | 18 |
| Valley Family Health Care Inc | 0547169591 | 45 |
| Entity Name | Boise Advanced Imaging Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013946235 PECOS PAC ID: 1850346180 Enrollment ID: O20050318000643 |
| Entity Name | Teton Radiology Diagnostic A Series Of Teton Group Enterprise |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013085604 PECOS PAC ID: 1254436959 Enrollment ID: O20070424000540 |
| Entity Name | Teton Radiology Madison Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407081060 PECOS PAC ID: 6901958024 Enrollment ID: O20090720000575 |
| Entity Name | Teton Vascular Institute Of Pocatello A Series Of Teton Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508224379 PECOS PAC ID: 8921306846 Enrollment ID: O20160409000003 |
| Entity Name | Cache Valley Vein |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831662311 PECOS PAC ID: 5294069563 Enrollment ID: O20231106001459 |
| Entity Name | Teton Radiology Caldwell |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336920420 PECOS PAC ID: 2365892742 Enrollment ID: O20240320000965 |
| Mailing Address | Practice Location Address |
|---|---|
| John Gambino, MD 11995 Singletree Ln, Suite 500, Eden Prairie, MN 55344-5347 Ph: (952) 595-1301 | John Gambino, MD 2275 Laurel Dr, Ontario, OR 97914-4107 Ph: (952) 595-1100 |
Mr. Robert T Yeager, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 964 W Idaho Ave, Snake River Radiology Pc, Ontario, OR 97914 Phone: 541-889-9545 Fax: 541-889-8376 |