Shelby Lynn Gordon, NP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

1-163097 Issued in AL

Practice address

5510 Promenade Point Pkwy NW # 160
Madison, AL 35758-6702

Phone

(256) 289-8470

Fax

(256) 993-3096

NPI assigned

Aug 5, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shelby Colquitt Smith Former name

Medicare fee-for-service enrollment

Enrolled in GA, AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Family Care IncGroup PAC ID 7618103748, 56 clinicians

Urgent Care Northwest PCGroup PAC ID 2062595598, 37 clinicians

American Family Care, LLCGroup PAC ID 9739087818, 180 clinicians

Orthosports1St PCGroup PAC ID 8729402037, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Advantage Family Care Inc

  • Urgent Care Clinic/Center
  • Florence, AL
  • NPI 1023447943
  Medicare reassignment Care Compare group NPD
• American Family Care, LLC

  • Primary Care Clinic/Center
  • Birmingham, AL
  • NPI 1669429080
  Medicare reassignment Care Compare group NPD
• Orthosports1St PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Hoover, AL
  • NPI 1730701673
  Medicare reassignment Care Compare group NPD
• Urgent Care Northwest PC

  • Family Medicine Physician
  • Jasper, AL
  • NPI 1548456494
  Medicare reassignment Care Compare group
• Emergency Physicians Group

  • Emergency Medicine Physician
  • Huntsville, AL
  • NPI 1659366649
  Medicare reassignment NPD
• Afc Physicians of Georgia Primary Care, PC

  • Primary Care Clinic/Center
  • Ft. Oglethorpe, GA
  • NPI 1780062380
  Medicare reassignment NPD
• Benning Hospitalist Services, LLC

  • Hospitalist Physician
  • Columbus, GA
  • NPI 1215442173
  Medicare reassignment NPD
• Emergency Group of Columbus, LLC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1316458227
  Medicare reassignment NPD
• Heritage Physician Services, LLC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1003321969
  Medicare reassignment NPD
• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  Medicare reassignment NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD
• Phoebe Sumter Medical Center, Inc.

  • General Acute Care Hospital
  • Americus, GA
  • NPI 1609001312
  Medicare reassignment NPD

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1073744280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 830525",
            "address_2": "DEPT# OWC 24",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352830525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 PROMENADE POINT PKWY NW # 160",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357586702",
            "telephone_number": "256-289-8470",
            "fax_number": "256-993-3096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6308 Adams Park Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319093528",
            "country_code": "US",
            "telephone_number": "229-942-8289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SHELBY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-05",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AL",
            "license": "1-163097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "513630481C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "SMITH",
            "middle_name": "COLQUITT",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Primary Care Nurse Practitioner in Madison, AL
• Providers in Madison, AL by specialty
• Primary Care Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; 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.