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DR. JACK ALAN GOMBERG M.D.
NPI 1114028057
Psychiatry & Neurology - Psychiatry in Elkins Park, PA

Active since September 25, 2006Opted out of Medicare · through Jan 1, 2028
8302 OLD YORK RD STE B4, ELKINS PARK, PA 19027(215) 628-8585(215) 886-1335 Get Directions Write a Review

NPPES record last updated: April 3, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jack Alan Gomberg M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK ALAN GOMBERG M.D. (NPI 1114028057) is an individual psychiatry provider in Elkins Park, Pennsylvania, licensed in Pennsylvania (MD015248E) and active in the NPI registry since September 2006. He has opted out of Medicare through January 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1114028057
Entity TypeIndividualMale
Primary Taxonomy2084P0800X
Provider Legal NameDR. JACK ALAN GOMBERGCredential: M.D.
Location Address8302 OLD YORK RD STE B4Elkins Park, PA 19027-1529
Mailing Address16 Breyer CtElkins Park, PA 19027-1350 · (215) 886-1335
Phone(215) 628-8585
Fax(215) 886-1335
Sole ProprietorNo
Enumeration DateSeptember 25, 2006
Last NPPES UpdateApril 3, 2023
NPPES CertifiedApril 3, 2023
✔ NPI 1114028057 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0800X
License✔ Licensed in PA · MD015248E
Definition
A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
8302 OLD YORK RD STE B4, Elkins Park, PA 19027
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Other Identifiers 3

OtherA36474PA · Amerihealth
Medicaid000839303 0003PA
Other000136474PA · Highmark Blue Shield

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jack Alan Gomberg M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2018 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2018
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19027 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$180.99 typical visit price
range $59.88 – $180.99
Typical copayment $45.24 (range $14.97 – $45.24)
Most-billed visit code 99205
Established Patient
$74.47 typical visit price
range $19.30 – $147.29
Typical copayment $18.61 (range $4.82 – $36.82)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Gomberg's NPI number?

The NPI number for Jack Gomberg is 1114028057. It was assigned to this individual provider in the NPPES registry on September 25, 2006.

Where is Jack Gomberg located?

Jack Gomberg practices at 8302 Old York Rd Ste B4, Elkins Park, PA 19027. The listed phone number is (215) 628-8585.

What is Jack Gomberg's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Jack Gomberg enrolled in Medicare?

No. Jack Gomberg has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jack Gomberg was last updated on April 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.