Active NPI
Gordon Lee Pattison III, D.D.S.
- Periodontics
- Los Angeles, CA
National Provider Identifier
1124351358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 22399
- Practice address
- 11859 Wilshire Blvd
Ste. 550
Los Angeles, CA 90025-6616 - Phone
- (310) 473-3800
- Fax
- (310) 473-9107
- NPI assigned
- Sep 4, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 22399 | CA | Primary |
Addresses
Primary practice location
11859 Wilshire Blvd
Ste. 550
Los Angeles, CA 90025-6616
Mailing address
11859 Wilshire Blvd
Ste. 550
Los Angeles, CA 90025-6616
Phone (310) 473-3800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 11, 2020 through Feb 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22399 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252022400000",
"number": "1124351358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11859 WILSHIRE BLVD",
"address_2": "STE. 550",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900256616",
"telephone_number": "310-473-3800",
"fax_number": "310-473-9107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11859 WILSHIRE BLVD",
"address_2": "STE. 550",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900256616",
"telephone_number": "310-473-3800",
"fax_number": "310-473-9107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTISON",
"first_name": "GORDON",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-04",
"last_updated": "2009-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "22399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.