| Gaps Health Or Pc | |
|
780 Commercial St Se Ste 100 Salem OR 97301-3465 | |
| (503) 588-5767 | |
| Not Available |
| Full Name | Gaps Health Or Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 780 Commercial St Se Ste 100, Salem, Oregon |
| Authorized Official Name and Position | Nitish Kosaraju (PHYSICIAN) |
| Authorized Official Contact | 8326289774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaps Health Or Pc Po Box 208003 Dallas TX 75320-8003 Ph: () - | Gaps Health Or Pc 780 Commercial St Se Ste 100 Salem OR 97301-3465 Ph: (503) 588-5767 |
| NPI Number | 1285279042 |
|---|---|
| Provider Enumeration Date | 11/15/2019 |
| Last Update Date | 11/15/2019 |
| Medicare PECOS PAC ID | 2264868546 |
|---|---|
| Medicare Enrollment ID | O20200204003064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285279042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Beth A Leone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134232515 PECOS PAC ID: 7214976372 Enrollment ID: I20050427001389 |
| Provider Name | Leandra J Gambee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356414478 PECOS PAC ID: 2163424441 Enrollment ID: I20070425000502 |
| Provider Name | Karen T Kahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508865015 PECOS PAC ID: 5597828996 Enrollment ID: I20090112000413 |
| Provider Name | Nita Vellody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912101338 PECOS PAC ID: 9032305461 Enrollment ID: I20101126000014 |
| Provider Name | Donald L Bons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073946711 PECOS PAC ID: 1951525880 Enrollment ID: I20140617000504 |
| Provider Name | Shelley Ann Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841483575 PECOS PAC ID: 3173618329 Enrollment ID: I20141006001315 |
| Provider Name | Nellyda M Anslow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225437734 PECOS PAC ID: 2668794157 Enrollment ID: I20141212000474 |
| Provider Name | Sarah George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538100847 PECOS PAC ID: 7315908852 Enrollment ID: I20150911001183 |
| Provider Name | Kemble Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205292703 PECOS PAC ID: 5597062398 Enrollment ID: I20160322001731 |
| Provider Name | Shirley Hanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730604166 PECOS PAC ID: 0042584187 Enrollment ID: I20170927004691 |
| Provider Name | Bonna R Ormond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093138539 PECOS PAC ID: 0648491043 Enrollment ID: I20171108000787 |
| Provider Name | Nathan M Ruden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982866679 PECOS PAC ID: 7315080884 Enrollment ID: I20180510001149 |
| Provider Name | Nitish Kosaraju |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184815383 PECOS PAC ID: 7012063886 Enrollment ID: I20191220002177 |
| Provider Name | Robert Scott Anthony |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194357764 PECOS PAC ID: 0042648388 Enrollment ID: I20200319001129 |
| Provider Name | Bradley J Goad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285617241 PECOS PAC ID: 1456244391 Enrollment ID: I20200403001021 |
| Provider Name | Sonali Wilborn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164523247 PECOS PAC ID: 0446317358 Enrollment ID: I20200415002060 |
| Provider Name | Jerome Wilborn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750351516 PECOS PAC ID: 2163412834 Enrollment ID: I20200415002277 |
| Provider Name | Jamison D Feramisco |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1043410871 PECOS PAC ID: 4688724602 Enrollment ID: I20200415002332 |
| Provider Name | David Brandenburg Marsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396272894 PECOS PAC ID: 9133559842 Enrollment ID: I20200421001294 |
| Provider Name | Ling Li |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396988416 PECOS PAC ID: 7214185826 Enrollment ID: I20200506000664 |
| Provider Name | Adam S Perelgut |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922460344 PECOS PAC ID: 5092005512 Enrollment ID: I20201127000085 |
| Provider Name | Daniela Falcone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578180857 PECOS PAC ID: 2769809227 Enrollment ID: I20201201000985 |
| Provider Name | Kaitlyn M Mcgowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619513769 PECOS PAC ID: 0143658328 Enrollment ID: I20201204001284 |
| Provider Name | Gloria Klimen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821048745 PECOS PAC ID: 8921314477 Enrollment ID: I20201207003119 |
| Provider Name | David Clayton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902037476 PECOS PAC ID: 2062319973 Enrollment ID: I20210108001382 |
| Provider Name | Maggie Mullican |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528674181 PECOS PAC ID: 1951714617 Enrollment ID: I20210119002452 |
| Provider Name | Mary Lou Freitag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962090621 PECOS PAC ID: 5991119141 Enrollment ID: I20210128002356 |
| Provider Name | Randolph Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568456036 PECOS PAC ID: 7517916463 Enrollment ID: I20210208001640 |
| Provider Name | Cameron G Peterson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1164604765 PECOS PAC ID: 5991855207 Enrollment ID: I20210324003100 |
| Provider Name | Roland Pua |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215009782 PECOS PAC ID: 2961403035 Enrollment ID: I20210406002325 |
| Provider Name | Tamara Parr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679159743 PECOS PAC ID: 0042616245 Enrollment ID: I20230317001267 |
| Provider Name | Vanessa Ann Basilio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851521512 PECOS PAC ID: 4486834603 Enrollment ID: I20230323000532 |
| Provider Name | Lillian Nagi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063851442 PECOS PAC ID: 0648594929 Enrollment ID: I20230621002796 |
| Provider Name | Lisa A Moment |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205250859 PECOS PAC ID: 8820220684 Enrollment ID: I20230628003442 |
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