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MR. GALLUS LEREH FOTABONG
NPI 1821755513
Nurse Practitioner - Gerontology in Lynn, MA

Active since November 17, 2021PECOS Enrolled

NPPES record last updated: November 17, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mr. Gallus Lereh Fotabong NPPES

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

MR. GALLUS LEREH FOTABONG (NPI 1821755513) is an individual gerontology provider in Lynn, Massachusetts, licensed in Massachusetts (AG11210066) and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1821755513
Entity TypeIndividualMale
Primary Taxonomy363LG0600X
Provider Legal NameMR. GALLUS LEREH FOTABONG
Location Address41 HARVEST STLynn, MA 01902-1122
Mailing Address41 Harvest StLynn, MA 01902-1122 · (781) 244-8473
Phone(781) 244-8473
Sole ProprietorNo
Enumeration DateNovember 17, 2021
NPPES CertifiedNovember 17, 2021
✔ NPI 1821755513 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License✔ Licensed in MA · AG11210066
41 HARVEST ST, Lynn, MA 01902
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource (Common Ground Healthcare).Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Gallus Lereh Fotabong 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 Gallus Fotabong reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Signify Health Medical Associates, PLLC
1,557 mi
General Practice
4055 VALLEY VIEW LN STE 700
Dallas, TX 75244
  • Reassigned Medicare billing, Massachusetts enrollment
  • 203 clinicians in this Medicare group
NPI 1750845863 (972) 715-3800

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01902 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
$90.70 typical visit price
range $58.86 – $177.36
Typical copayment $22.67 (range $14.71 – $44.34)
Most-billed visit code 99203
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
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.

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 Gallus Fotabong's NPI number?

The NPI number for Gallus Fotabong is 1821755513. It was assigned to this individual provider in the NPPES registry on November 17, 2021.

Where is Gallus Fotabong located?

Gallus Fotabong practices at 41 Harvest St, Lynn, MA 01902. The listed phone number is (781) 244-8473.

What is Gallus Fotabong's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Gallus Fotabong enrolled in Medicare?

Yes. Gallus Fotabong is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Gallus Fotabong's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Gallus Fotabong reassigns Medicare benefits to Signify Health Medical Associates, PLLC (Dallas, TX). 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 Gallus Fotabong's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Gallus Fotabong accept?

Health plans from CareSource (Common Ground Healthcare) list Gallus Fotabong as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Gallus Fotabong was last updated on November 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.