Kenyetta Michelle Gordon, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C186176 Issued in CA

Practice address

1675 Northcrest Dr
Crescent City, CA 95531-8928

Phone

(707) 464-2750

NPI assigned

Aug 31, 2007

Last updated

May 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR, TX, CA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Family Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Indian Health Services, Inc.Group PAC ID 9830085075, 26 clinicians

Open Door Community Health CentersGroup PAC ID 9436067485, 113 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Coast Home Care Home health agency, Crescent City, CA, CCN 057427
• Sutter Coast Hospital Hospital, Crescent City, CA, CCN 050417
• Curry General Hospital Hospital, Gold Beach, OR, CCN 381322
• Providence St Joseph Hospital Hospital, Eureka, CA, CCN 050006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgordon720208@direct.ochin.org
• Direct secure messaging: kgordon743440@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Arcata, CA
  • NPI 1497751572
  Medicare reassignment Care Compare group NPD
• Bad River Band of Lake Superior Tribe of Chippewa Indians Wis

  • Federally Qualified Health Center (FQHC)
  • Ashland, WI
  • NPI 1699701375

  TX

  Medicare reassignment NPD
• Ess of Fordyce LLC

  • Emergency Medicine Physician
  • Fordyce, AR
  • NPI 1821547977
  Medicare reassignment NPD
• Hospital Care Consultants of Fordyce LLC

  • Hospitalist Physician
  • Fordyce, AR
  • NPI 1316497464
  Medicare reassignment NPD
• South Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • El Dorado, AR
  • NPI 1942435458
  Medicare reassignment NPD
• Texarkana Behavioral Associates, L.C.

  dba Valley Behavioral Health System Outpatient Program

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Barling, AR
  • NPI 1467483677
  Medicare reassignment NPD
• Open Door Community Health Centers

  dba Del Norte Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Crescent City, CA
  • NPI 1497840656
  Care Compare group NPD
• Open Door Community Health Centers

  dba Open Door Downtown

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
  • NPI 1831713452
  NPD
• Ridgecrest Regional Hospital

  dba Ridgecrest Regional Hospital Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Ridgecrest, CA
  • NPI 1164067971
  NPD
• Ridgecrest Regional Hospital

  • Critical Access Hospital
  • Ridgecrest, CA
  • NPI 1447253125
  NPD
• United Indian Health Services, Inc.

  • Community Health Clinic/Center
  • Weitchpec, CA
  • NPI 1265438154
  NPD
• United Indian Health Services, Inc.

  • Community Health Clinic/Center
  • Arcata, CA
  • NPI 1699506121
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Joseph Health Northern California, LLC

  dba Providence Humboldt Home Infusion

  • Home Infusion Therapy Pharmacy
  • Eureka, CA
  • NPI 1568422319

  Hospital

  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  dba Providence St. Joseph Hospital

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1609858950
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  dba Providence St. Joseph Hospital

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1891900635
  Care Compare affiliation
• Sutter Coast Hospital

  • General Acute Care Hospital
  • Crescent City, CA
  • NPI 1457367062
  Care Compare affiliation
• Sutter Coast Hospital

  dba Sutter Coast Home Care

  • Home Health Agency
  • Crescent City, CA
  • NPI 1609881499
  Care Compare affiliation
• Sutter Coast Hospital

  dba Sutter Coast Community Clinic

  • General Practice Physician
  • Crescent City, CA
  • NPI 1700960267

  Hospital

  Care Compare affiliation
• Curry Health District

  dba Curry Medical Center (formerly Brookings Medical Center)

  • Critical Access Hospital Clinic/Center
  • Brookings, OR
  • NPI 1083656367
  Care Compare affiliation
• Curry Health District

  dba Curry General Hospital

  • Critical Access Hospital
  • Gold Beach, OR
  • NPI 1487696985
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1013101161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 NORTHCREST DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318928",
            "telephone_number": "707-464-2750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 N Indian Rd",
            "address_purpose": "LOCATION",
            "city": "Smith River",
            "state": "CA",
            "postal_code": "955679509",
            "country_code": "US",
            "telephone_number": "707-487-0215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KENYETTA",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "19863",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-6423",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C186176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013101161",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Helen Godwyn, RD CDE
• Dulce Rafaela Gomez
• Maria Raquel Gonzales-Flores
• David Gonzales
• Samantha Gonzalez
• Vicki R Gordon, MD PHD
• John Michael Goss, P.T.
• Gray Chiropractic PC
• Sean Gray, D.C.
• Holly Greene

• Family Medicine Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.