DR. DAVID LAKE GORMSEN D.O.
NPI 1619014602
Emergency Medicine - Pediatric Emergency Medicine in Canton, OH

Q: What is David Gormsen's NPI number?

The NPI number for David Gormsen is 1619014602. It was assigned to this individual provider in the NPPES registry on January 31, 2007.

Q: What is David Gormsen's specialty?

The primary specialty registered for this NPI is Emergency Medicine, specializing in Pediatric Emergency Medicine, with taxonomy code 207PP0204X.

Q: When was this NPI record last updated?

The NPPES record for David Gormsen was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.

Active since January 31, 2007PECOS Enrolled

1320 MERCY DR NW, CANTON, OH 44708(330) 489-1074(330) 489-1487 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. David Lake Gormsen D.o. NPPES

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

DR. DAVID LAKE GORMSEN D.O. (NPI 1619014602) is an individual pediatric emergency medicine provider in Canton, Ohio, licensed in Ohio (34002838) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619014602

Entity TypeIndividualMale

Primary Taxonomy207PP0204X

Provider Legal NameDR. DAVID LAKE GORMSENCredential: D.O.

Location Address1320 MERCY DR NWCanton, OH 44708-2614

Mailing Address4189 Songbird TrlStow, OH 44224-2572 · (330) 688-4160 · Fax (330) 489-1487

Phone(330) 489-1074

Fax(330) 489-1487

Sole ProprietorYes

Enumeration DateJanuary 31, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1619014602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency Medicine · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207PP0204X

License✔ Licensed in OH · 34002838

Definition

Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department.

1320 MERCY DR NW, Canton, OH 44708

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Other Identifiers 1

Other34002838OH · Medical License Number

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. David Lake Gormsen D.o. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 44708 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

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

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.

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.

AMANDA G GILLIS CRNA

Nurse Anesthetist, Certified Registered