NPIMap

Individual provider Active NPI

Kevin C Gordon, M.D.

  • Gastroenterology Physician
  • Wyomissing, PA
National Provider Identifier
1174815625
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD460173 Issued in PA
Practice address
1011 Reed Ave
Suite 300
Wyomissing, PA 19610-2002
Phone
(610) 374-4401
Fax
(610) 374-7140
NPI assigned
May 3, 2011
Last updated
Mar 31, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Gastroenterology Physician 207RG0100X MD460173 PA Primary

Addresses

Primary practice location

1011 Reed Ave
Suite 300
Wyomissing, PA 19610-2002

Mailing address

1011 Reed Ave
Suite 300
Wyomissing, PA 19610-2002
Phone (610) 374-4401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20170705000033 PA Practitioner - GastroenterologyPractitioner - Internal Medicine 5698044840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Temple University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional Gastroenterology Associates of Lancaster, LTD.Group PAC ID 4688575434, 248 clinicians

Practice addresses (Care Compare)

1011 Reed Ave
Suite 300
Wyomissing, PA 19610-2002
Phone (610) 374-4401

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy158
Upper gastrointestinal (GI) endoscopy for acid reflux142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD460173PAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Gastroenterology Associates of Lancaster, LTD. Gastroenterology CurrentSince Jul 1, 2019 Accepting new patients
Midatlantic Endoscopy LLC Current Accepting new patients
Regional Gastroenterology Associates of Lancaster, LTD. CurrentSince Jul 1, 2019 Accepting new patients
Westwyo Services LP PastSince May 1, 2015 Accepting new patients

Locations

2112 Harrisburg Pike
Ste 202
Lancaster, PA 17601
Phone (717) 544-3500

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

1011 Reed Ave
Ste 300
Wyomissing, PA 19610
Phone (610) 374-4401

Interoperability endpoints

  • Direct secure messaging: kevingordon@ddal.allscriptsdirect.net

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 11

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": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1174815625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 REED AVE",
            "address_2": "SUITE 300",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196102002",
            "telephone_number": "610-374-4401",
            "fax_number": "610-374-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 REED AVE",
            "address_2": "SUITE 300",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196102002",
            "telephone_number": "610-374-4401",
            "fax_number": "610-374-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KEVIN",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-03",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD460173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyomissing, PA

Sources for this page

Verify at the official NPI Registry.