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DR. CARL D GANDOLA MD
NPI 1376529461
Internal Medicine in Covington, KY

Active since December 20, 2005PECOS Enrolled
1500 JAMES SIMPSON JR WAY, SUITE 201, COVINGTON, KY 41011(859) 655-8980(859) 655-8981 Get Directions Write a Review

NPPES record last updated: September 12, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 12, 2018, Nov 11, 2015 (2 updates tracked since 2015).

About Dr. Carl D Gandola Md NPPES

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

DR. CARL D GANDOLA MD (NPI 1376529461) is an individual internal medicine provider in Covington, Kentucky, licensed in Kentucky (45251) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376529461
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. CARL D GANDOLACredential: MD
Location Address1500 JAMES SIMPSON JR WAY, SUITE 201Covington, KY 41011-0801
Mailing AddressPo Box 635283Cincinnati, OH 45263-5283 · (859) 655-8980 · Fax (859) 655-8981
Phone(859) 655-8980
Fax(859) 655-8981
Sole ProprietorNo
Enumeration DateDecember 20, 2005
Last NPPES UpdateSeptember 12, 20182 updates tracked since enumeration
✔ NPI 1376529461 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in KY · 45251✔ Licensed in KY · TP405✔ Licensed in OH · 35043698
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1500 JAMES SIMPSON JR WAY, Covington, KY 41011
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Other Identifiers 2

Medicaid401578OH
Medicaid64785306KY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Carl D Gandola Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Carl Gandola reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Summit Medical Group, Inc.
4.2 mi
Urgent Care
2626 ALEXANDRIA PIKE
Highland Heights, KY 41076
  • Reassigned Medicare billing, Kentucky enrollment
  • 946 clinicians in this Medicare group
NPI 1881026169 (859) 757-0434

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
27 services24 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
25 services22 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
15 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41011 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
$122.77 typical visit price
range $52.76 – $162.27
Typical copayment $30.69 (range $13.19 – $40.56)
Most-billed visit code 99204
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
56%66 patients3/55-star benchmark: 100%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
89%130 patients4/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
31%178 patients2/55-star benchmark: 100%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
49%141 patients2/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers23 claims46 services$4.47 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
4 suppliers19 claims19 services$14.23 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
3 suppliers14 claims14 services$54.83 avg. paid by Medicare
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613
DME-Drugs Administered Through DME · category DG006N
3 suppliers15 claims945 services$0.03 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
3 suppliers11 claims11 services$25.99 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETRA BRADSHAW RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
DR. EUGENE JAMES BURCHELL JR. M.D.
Obstetrics & Gynecology
1500 JAMES SIMPSON JR WAY, WOULD CARE DEPT.
COVINGTON, KY 41011
Kenton County (859) 655-1100
WAEL E EID MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1500 JAMES SIMPSON JR WAY, SUITE 301
COVINGTON, KY 41011
Kenton County (859) 655-8910
MR. ERIC R WOOD PA-C
Physician Assistant
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-1100
MRS. BRIANA L. VITUCCI RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
RAE ELIZAGARAY RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
DR. NED MEHLMAN M.D.
Internal Medicine (Cardiovascular Disease)
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-9500
IRINA KORABLEVA MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910

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 Carl Gandola's NPI number?

The NPI number for Carl Gandola is 1376529461. It was assigned to this individual provider in the NPPES registry on December 20, 2005.

Where is Carl Gandola located?

Carl Gandola practices at 1500 James Simpson Jr Way Suite 201, Covington, KY 41011. The listed phone number is (859) 655-8980.

What is Carl Gandola's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Carl Gandola enrolled in Medicare?

Yes. Carl Gandola is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Carl Gandola's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Carl Gandola reassigns Medicare benefits to Summit Medical Group, Inc. (Highland Heights, KY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Carl Gandola's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Carl Gandola was last updated on September 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.