NPIMap

Individual provider Active NPI

Gordon Colin Gunn, MD

  • Gynecology Physician
  • Fullerton, CA
National Provider Identifier
1194829184
Registry record updated Mar 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
C27175 Issued in CA
Practice address
100 E Valencia Mesa Dr
Suite # 215
Fullerton, CA 92835-3813
Phone
(714) 912-2211
Fax
(714) 213-8750
NPI assigned
Sep 11, 2006
Last updated
Mar 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X C27175 CA Primary

Addresses

Primary practice location

100 E Valencia Mesa Dr
Suite # 215
Fullerton, CA 92835-3813

Mailing address

100 E Valencia Mesa Dr
Suite # 215
Fullerton, CA 92835-3813
Phone (714) 912-2211

Other identifiers 2

IdentifierTypeStateIssuer
00C271750MedicaidCA
WC27175COtherCAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20110513000679 CA Practitioner - Obstetrics/Gynecology 2567350044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Baylor College of Medicine, 1964
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 215
Fullerton, CA 92835-3800
Phone (714) 912-2211

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gordon Gunn M.D Inc a Medical Corporation CurrentSince Feb 27, 2013 Accepting new patients
Ricarda Benz MD, Inc Gynecology CurrentSince Aug 30, 2013 Accepting new patients
St Jude Hospital Inc Past Accepting new patients

Locations

100 E Valencia Mesa Dr
Ste 215
Fullerton, CA 92835
Phone (714) 879-6533

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1194829184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR",
            "address_2": "SUITE # 215",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353813",
            "telephone_number": "714-912-2211",
            "fax_number": "714-213-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR",
            "address_2": "SUITE # 215",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353813",
            "telephone_number": "714-912-2211",
            "fax_number": "714-213-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNN",
        "first_name": "GORDON",
        "middle_name": "COLIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CA",
            "license": "C27175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C271750",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "WC27175C",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.