NPIMap

Individual provider Active NPI

Latoya Gordon Niles, PAC

  • Physician Assistant
  • Durham, NC
National Provider Identifier
1093882532
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3667 Issued in TN
Practice address
2511 Old Cornwallis Rd
Suite 200
Durham, NC 27713-1869
Phone
(919) 932-5700
Fax
(919) 933-6881
NPI assigned
Nov 29, 2006
Last updated
Jul 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3667 TN Primary
Physician Assistant 363A00000X 0010-06340 NC

Addresses

Primary practice location

2511 Old Cornwallis Rd
Suite 200
Durham, NC 27713-1869

Mailing address

237 E Main St
Hendersonville, TN 37075-2549
Phone (615) 431-3640

Other names 1

  • Ms. Latoya Breneka Gordon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181010000237 TN Practitioner - Physician Assistant 4183624943 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CH MSSP Services TN PLLCGroup PAC ID 0042603656, 48 clinicians
Bluesky Housecalls, LLCGroup PAC ID 3476859257, 12 clinicians
Curana Health of Tennessee LLCGroup PAC ID 7416261482, 56 clinicians

Practice addresses (Care Compare)

Memphis, TN 38103
Phone (337) 991-9276

109 Westpark Dr
Suite 330
Brentwood, TN 37027-5062
Phone (615) 340-6840

5865 Ridgeway Ctr Pkwy
Memphis, TN 38120-4032
Phone (337) 991-9276

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3667TNMDClinical Neuropsychologist
0010-06340NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GJGCDA/Endpoint/GJGCDA

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1093882532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 E MAIN ST",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752549",
            "telephone_number": "615-431-3640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 OLD CORNWALLIS RD",
            "address_2": "SUITE 200",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277131869",
            "telephone_number": "919-932-5700",
            "fax_number": "919-933-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILES",
        "first_name": "LATOYA",
        "middle_name": "GORDON",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3667",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATOYA",
            "last_name": "GORDON",
            "middle_name": "BRENEKA",
            "prefix": "MS.",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.