Active NPI
Chanel Gordon
- Prosthetics Case Management
- Mesa, AZ
National Provider Identifier
1184267346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- Practice address
- 1731 W Baseline Rd Ste 107
Mesa, AZ 85202-5730 - Phone
- (480) 687-2336
- NPI assigned
- Oct 21, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | Primary |
Addresses
Primary practice location
1731 W Baseline Rd Ste 107
Mesa, AZ 85202-5730
Mailing address
1731 W Baseline Rd Ste 107
Mesa, AZ 85202-5730
Phone (513) 828-5597
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Cyssalon@gmail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571616000000",
"number": "1184267346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1731 W BASELINE RD STE 107",
"city": "MESA",
"state": "AZ",
"postal_code": "852025730",
"telephone_number": "513-828-5597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1731 W BASELINE RD STE 107",
"city": "MESA",
"state": "AZ",
"postal_code": "852025730",
"telephone_number": "480-687-2336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "CHANEL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-21",
"last_updated": "2019-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist, Prosthetics Case Management",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Cyssalon@gmail.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1731 W Baseline Rd Ste 107",
"city": "Mesa",
"state": "AZ",
"country_code": "US",
"postal_code": "852025730",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.