NPIMap

Organization Active NPI

Maxie Gordon MD & Associates, PLLC

  • Psychiatry Physician
  • Clinton, MS
National Provider Identifier
1114105665
Registry record updated Aug 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
9801288 Issued in MS
Legal business name
MAXIE GORDON MD & ASSOCIATES, PLLC
Practice address
590 Springridge Rd
Clinton, MS 39056
Phone
(601) 488-8101
Fax
(662) 287-5678
NPI assigned
Feb 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2019

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

Authorized official

Name
Teandra Walton
Title
Director of Business Operations
Phone
(601) 488-8101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 9801288 MS Primary

Addresses

Primary practice location

590 Springridge Rd
Clinton, MS 39056

Mailing address

590 Springridge Rd
Clinton, MS 39056-5606
Phone (601) 488-8101

Other practice location 1

102E N Cass St
Corinth, MS 38834-0000
Phone (662) 665-1545

Other identifiers 1

IdentifierTypeStateIssuer
08723392MedicaidMS

Other names 1

  • Gordon Medical Arts Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080616000407 MS Part B Supplier - Clinic/Group Practice 1658442843 Receives reassigned benefits from 8 practitioners
Practice locations: Clinton, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2273330Gordon Medical Arts Clinic590 Springridge Rd, Clinton, MS 39056Certificate of waiverDec 11, 2026

National Provider Directory

National Provider Directory

Locations

590 Springridge Rd
Clinton, MS 39056
Phone (601) 488-8101

102E N Cass St
Corinth, MS 38834
Phone (601) 862-4937

102 N Cass St
Corinth, MS 38834
Phone (601) 862-4937

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566345600000",
    "number": "1114105665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 SPRINGRIDGE RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565606",
            "telephone_number": "601-488-8101",
            "fax_number": "662-287-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 SPRINGRIDGE RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "39056",
            "telephone_number": "601-488-8101",
            "fax_number": "662-287-5678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102E N CASS ST",
            "address_purpose": "LOCATION",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388340000",
            "country_code": "US",
            "telephone_number": "662-665-1545",
            "fax_number": "662-287-5678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIE GORDON MD & ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2019-08-21",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "TEANDRA",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "601-488-8101"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "9801288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08723392",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gordon Medical Arts Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.