Individual provider Active NPI

Gordon D Phillips, M.D.

  • Public Health & General Preventive Medicine Physician
  • Redlands, CA
National Provider Identifier
1033158670
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
License
G58853 Issued in CA
Practice address
2 W Fern Ave
Redlands, CA 92373-5916
Phone
(909) 793-3311
Fax
(909) 793-2916
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G54853 CA
Public Health & General Preventive Medicine Physician 2083P0901X G58853 CA Primary

Addresses

Primary practice location

2 W Fern Ave
Redlands, CA 92373-5916

Mailing address

PO Box 10069
San Bernardino, CA 92423-0069
Phone (909) 793-3311

Other identifiers 1

IdentifierTypeStateIssuer
00G548530MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20101115001180 CA Practitioner - Preventive Medicine 8123213220 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Preventive Medicine
Education
Loma Linda University School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exer Medical CorporationGroup PAC ID 9032359534, 336 clinicians

Practice addresses (Care Compare)

839 Highland Springs Ave
Suite 101
Beaumont, CA 92223-5767
Phone (951) 521-1580

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G54853CAMDEmergency Medicine Physician
G58853CAMDPublic Health & General Preventive Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Exer Medical Corporation CurrentSince Sep 1, 2024 Accepting new patients
Beaver Medical Group P C CurrentSince Aug 1, 2010 Accepting new patients
Beaver Medical Group P C CurrentSince Aug 1, 2010 Accepting new patients
Beaver Medical Group P C Past Accepting new patients

Locations

26777 Agoura Rd
Calabasas, CA 91302
Phone (818) 880-2225

26777 Agoura Rd
Ste 4
Calabasas, CA 91302
Phone (818) 880-2225

235 E 17th St
Costa Mesa, CA 92627
Phone (949) 688-2010

2381 Rosecrans Ave
Ste 115
El Segundo, CA 90245
Phone (213) 335-7355

7000 Boulder Ave
Ste 103
Highland, CA 92346
Phone (515) 441-6271

7000 Boulder Ave
Highland, CA 92346

2 W Fern Ave
Redlands, CA 92373
Phone (909) 335-4137

245 Terracina Blvd
Ste 102
Redlands, CA 92373
Phone (909) 406-2671

25548 The Old Rd
Ste U1
Stevenson Ranch, CA 91381
Phone (661) 556-9020

701 N Wendy Dr
Thousand Oaks, CA 91320
Phone (805) 375-4400

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1033158670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10069",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924230069",
            "telephone_number": "909-793-3311",
            "fax_number": "909-793-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W FERN AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735916",
            "telephone_number": "909-793-3311",
            "fax_number": "909-793-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "GORDON",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G54853",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "CA",
            "license": "G58853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G548530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.