TIM B GANNON P.A.
NPI 1780992024
Physician Assistant - Medical in Santa Fe, NM

Q: What is Tim Gannon's NPI number?

The NPI number for Tim Gannon is 1780992024. It was assigned to this individual provider in the NPPES registry on September 21, 2010.

Q: What is Tim Gannon's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Tim Gannon was last updated on March 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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 September 21, 2010PECOS EnrolledAccepts Medicare Assignment

649 HARKLE RD STE E, SANTA FE, NM 87505(505) 955-9454(505) 216-9067 Get Directions Write a Review

NPPES record last updated: March 26, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Tim B Gannon P.a. NPPES

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

TIM B GANNON P.A. (NPI 1780992024) is an individual medical provider in Santa Fe, New Mexico, licensed in New Mexico (PA2010-0058) and active in the NPI registry since September 2010. He is enrolled in Medicare PECOS, is affiliated with Christus St Vincent Regional Medical Center, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1780992024

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameTIM B GANNONCredential: P.A.

Location Address649 HARKLE RD STE ESanta Fe, NM 87505-4765

Mailing AddressPo Box 6880Santa Fe, NM 87502-6880 · (505) 955-9454 · Fax (505) 216-9067

Phone(505) 955-9454

Fax(505) 216-9067

Sole ProprietorNo

Medical School CMSOtherGraduated 2010

Enumeration DateSeptember 21, 2010

Last NPPES UpdateMarch 26, 2026

NPPES CertifiedMarch 26, 2026

✔ NPI 1780992024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in NM · PA2010-0058

649 HARKLE RD STE E, Santa Fe, NM 87505

Open in Google Maps ↗

Other Identifiers 1

Medicaid25773119NM

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tim B Gannon P.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID143417915

PECOS Enrollment IDI20230919000119

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Christus St Vincent Regional Medical Center

Acute Care Hospitals · Santa Fe, NM

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number320002

Location455 St Michael's DriveSanta Fe, NM 87505 · Santa Fe County

Emergency services Birthing friendly

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.

OLUYOMI OBAFEMI M.D.

Preventive Medicine (Public Health & General Preventive Medicine)