Active NPI
Donal Kevin Gordon, MD
- Family Medicine Physician
- Cedar Rapids, IA
National Provider Identifier
1013971092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36376
- Practice address
- 1201 3Rd Ave SE
Cedar Rapids, IA 52403-4009 - Phone
- (319) 730-7300
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36376 | IA | Primary |
Addresses
Primary practice location
1201 3Rd Ave SE
Cedar Rapids, IA 52403-4009
Mailing address
PO Box 2205
Cedar Rapids, IA 52406-2205
Phone (319) 730-7300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0460865 | Medicaid | IA | |
| P00731432 | Other | RR MEDICARE MEMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36376 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Iowa Health Center | Past | Accepting new patients | |
| Mercy Medical Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1013971092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2205",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524062205",
"telephone_number": "319-730-7300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 3RD AVE SE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524034009",
"telephone_number": "319-730-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DONAL",
"middle_name": "KEVIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "36376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460865",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE MEMBER",
"identifier": "P00731432",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.