Active NPI
Philip J Gordon, DDS
- Dentist
- Kansas City, MO
National Provider Identifier
1225265010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2009013194
- Practice address
- 5844 NW Barry Rd
Ste. 220
Kansas City, MO 64154-1465 - Phone
- (816) 505-2222
- NPI assigned
- Jun 18, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2009013194 | MO | Primary |
Addresses
Primary practice location
5844 NW Barry Rd
Ste. 220
Kansas City, MO 64154-1465
Mailing address
5844 NW Barry Rd
Ste. 220
Kansas City, MO 64154-1465
Phone (816) 505-2222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2022 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009013194 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1225265010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5844 NW BARRY RD",
"address_2": "STE. 220",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641541465",
"telephone_number": "816-505-2222",
"fax_number": "816-505-1334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5844 NW BARRY RD",
"address_2": "STE. 220",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641541465",
"telephone_number": "816-505-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "PHILIP",
"middle_name": "J",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-18",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2009013194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.