Individual provider Active NPI

Shimeal Gordon

  • Gerontology Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1194568683
Registry record updated Nov 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
0024193790 Issued in VA
Practice address
9530 Cosner Dr Ste 200
Fredericksburg, VA 22408-7760
Phone
(540) 373-1331
NPI assigned
Jun 13, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 0024193790 VA Primary
Home Health Registered Nurse 163WH0200X 0001289844 VA

Addresses

Primary practice location

9530 Cosner Dr Ste 200
Fredericksburg, VA 22408-7760

Mailing address

9530 Cosner Dr Ste 200
Fredericksburg, VA 22408-7760
Phone (540) 373-1331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20250925000244 VA Practitioner - Nurse Practitioner 2567967102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173

Hospital & facility affiliations

  • Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022
  • Spotsylvania Regional Medical Center Hospital, Fredericksburg, VA, CCN 490141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0001289844VAMDHome Health Registered Nurse
0024193790VAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Oct 1, 2025 Accepting new patients
Privia Medical Group, LLC CurrentSince Oct 1, 2025 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

2500 Charles St
Fredericksburg, VA 22401
Phone (540) 373-1331

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762041600000",
    "number": "1194568683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9530 COSNER DR STE 200",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224087760",
            "telephone_number": "540-373-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9530 COSNER DR STE 200",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224087760",
            "telephone_number": "540-373-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SHIMEAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-13",
        "last_updated": "2025-11-02",
        "certification_date": "2025-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024193790",
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "VA",
            "license": "0001289844",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.