Carrie Kallenbach Gordon, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12246 Issued in CA

Practice address

300 Bradford Street
Maguire Correctional Facility
Redwood City, CA 94063

Phone

(650) 363-4241

NPI assigned

Dec 22, 2011

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 CA

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

Specialty

Nurse Practitioner

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Mateo Medical Center Hospital, San Mateo, CA, CCN 050113

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: afterhourspediatricsurgentcare.carriegordon@129385.advancedmd-direct.com
• Direct secure messaging: cgordon19028@smch.direct-ci.com

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.

• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  Medicare reassignment NPD
• County of San Mateo

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1528432481
  NPD

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

• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1003985755
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1023196011

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1265522619

  Hospital

  Care Compare affiliation
• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1386713030
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1386728533

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1568540557

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • South San Francisco, CA
  • NPI 1750460671

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Half Moon Bay, CA
  • NPI 1841379765

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1134498926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 BRADFORD AVENUE",
            "address_2": "MAGUIRE CORRECTIONAL FACILITY",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94063",
            "telephone_number": "650-363-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BRADFORD STREET",
            "address_2": "MAGUIRE CORRECTIONAL FACILITY",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94063",
            "telephone_number": "650-363-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CARRIE",
        "middle_name": "KALLENBACH",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-22",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "12246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yesela Iliana Gonzalez, BS
• Good Smiles LLC
• Scott Alan Goode, PHD, PHD
• Varun Gorantla, M.D.
• Andrea Gordon
• Paul Gorman, M.D.
• Brenda Denise Gormley, RD
• Lenore Georgette Gotelli
• Shantha Gowda, PSYD
• Ashu Goyal, MD

• Family Nurse Practitioner in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; 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.