Earl Mark Gordon, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

G 35140 Issued in CA

Practice address

2021 Santa Monica Blvd Ste 421E
Santa Monica, CA 90404-2144

Phone

(310) 453-4599

Fax

(310) 453-6620

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: egordon473115@oc.providencedirect.org
• Direct secure messaging: egordon58904@direct.uclahealth.org

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.

• Pacific Medical and Nephrology Associates Inc.

  • Nephrology Physician
  • Santa Monica, CA
  • NPI 1891756508
  NPD Authorized official
• Regents Univ of Calif Los Angeles

  dba Resnick Neuropsychiatric Hospital at UCLA

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)
• The Regents of the University of California

  dba Santa Monica UCLAMC and Orthopedic Hospital

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1982849105
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1053534925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD",
            "address_2": "SUITE # 765 - W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042102",
            "telephone_number": "310-453-4599",
            "fax_number": "310-453-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 SANTA MONICA BLVD STE 421E",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042144",
            "telephone_number": "310-453-4599",
            "fax_number": "310-453-6620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Santa Monica Blvd",
            "address_2": "SUITE # 765 - W",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904042102",
            "country_code": "US",
            "telephone_number": "310-453-4599",
            "fax_number": "310-453-6620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "EARL",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G 35140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ 73491 Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA MED. LICENSE",
            "identifier": "G 35140",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egordon473115@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2021 Santa Monica Blvd Ste 421E",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904042144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gordon Averill, DMD and Angie Dunkling, DMD Dental Services Inc (26th Street Dental)
• Evan Ross Gordon-Wollin, D.O.
• Alan T Gordon, LCSW
• Bruce R. Gordon, PH.D.
• Claire Gordon
• Edward Francis Gordon, L.AC.
• Erlinda Maria Gordon, MD
• Jay N. Gordon, M.D., F.A.A.P.
• Martin A. Gordon, M.D.
• Rita Gordon, CNM

• Nephrology Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.