NPIMap

Individual provider Active NPI

Krista Gordon, MD

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1164426193
Registry record updated Oct 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21237 Issued in OK
Practice address
5366 NW Cache Rd Ste 6
Lawton, OK 73505-3353
Phone
(580) 536-7546
Fax
(580) 581-2051
NPI assigned
Jun 8, 2005
Last updated
Oct 5, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 21237 OK Primary

Addresses

Primary practice location

5366 NW Cache Rd Ste 6
Lawton, OK 73505-3353

Mailing address

5366 NW Cache Rd Ste 6
Lawton, OK 73505-3353
Phone (580) 536-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20071121000501 OK Practitioner - Family Practice 4486742640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5366 NW Cache Rd
Suite 6
Lawton, OK 73505-3353
Phone (580) 536-7546

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Krista Gordon MD PC Family Medicine CurrentSince Nov 26, 2007 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients
Comanche County Hospital Authority Past Accepting new patients

Locations

5366 NW Cache Rd
Ste 6
Lawton, OK 73505
Phone (580) 536-7546

Organizations & group practices 4

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": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1164426193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5366 NW CACHE RD STE 6",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735053353",
            "telephone_number": "580-536-7546",
            "fax_number": "580-581-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 NW CACHE RD STE 6",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735053353",
            "telephone_number": "580-536-7546",
            "fax_number": "580-581-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KRISTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-08",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "21237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.