Phebe Gordon, NPC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

CNP 4837 Issued in MN

Practice address

1027 Washington Ave
Detroit Lakes, MN 56501-3409

Phone

(218) 847-5611

NPI assigned

Oct 3, 2016

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

Medicare fee-for-service enrollment

Enrolled in MN

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• St. Marys Regional Health Center

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Medicare reassignment NPD
• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482
  NPD
• St. Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Mahnomen, MN
  • NPI 1750725586
  NPD

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1093264996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "PHEBE",
        "credential": "NPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-03",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "CNP 4837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emmalee Gavle
• Jennifer Rebecca Gifford, MS, LADC
• Samuel Dylan Gobel, LPCC
• Mitchell B Goldstein, MD
• Kayla Gordon
• Wendy Lynn Gordon, R.D., RDH
• Whitney T Grabow, PT
• Grand St Paul CVS LLC
• Cynthia Lou Gray, OTR
• Jeffrey C Gregory, PH.D.

• Pediatric Nurse Practitioner in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; 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.