NPIMap

Individual provider Active NPI

Kristin Shallcross Gordon, D.O.

  • Family Medicine Physician
  • Manhasset, NY
National Provider Identifier
1215242326
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2782841 Issued in NY
Practice address
600 Community Dr Ste 302
Manhasset, NY 11030-3818
Phone
(516) 823-8808
NPI assigned
Aug 12, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

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 2782841 NY Primary

Addresses

Primary practice location

600 Community Dr Ste 302
Manhasset, NY 11030-3818

Mailing address

PO Box 3055
Sag Harbor, NY 11963-0403
Phone (631) 377-1036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180503002241 NY Practitioner - Family Practice 0840588562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peconic Bay Primary Medical CareGroup PAC ID 7113817602, 72 clinicians

Practice addresses (Care Compare)

80 E Montauk Hwy
Suite 102
Hampton Bays, NY 11946-1878
Phone (631) 728-4500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2782841NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peconic Bay Primary Medical Care CurrentSince Mar 2, 2022 Accepting new patients
North Shore - Lij Medical PC CurrentSince Sep 22, 2018 Accepting new patients
North Shore-Lij Medical PC Family Medicine CurrentSince Sep 22, 2018 Accepting new patients
Prime Care Medical of Long Island, PC Family Medicine PastSince Mar 2, 2022 Accepting new patients

Locations

80 E Montauk Hwy
Ste 102
Hampton Bays, NY 11946
Phone (631) 369-5000

300 Community Dr
Plandome, NY 11030

31 Main Rd
Ste 1
Riverhead, NY 11901
Phone (631) 298-4479

1267 E Main St
Riverhead, NY 11901
Phone (631) 369-0490

34 Commerce Ave
Riverhead, NY 11901
Phone (631) 591-3000

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kgordon65464@northwell.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1215242326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3055",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630403",
            "telephone_number": "631-377-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COMMUNITY DR STE 302",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303818",
            "telephone_number": "516-823-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KRISTIN",
        "middle_name": "SHALLCROSS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-12",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "2782841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.