Joellen Gordon, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 2812 Issued in FL

Practice address

6821 W Hillsborough Ave
Ste #19
Tampa, FL 33634-5003

Phone

(813) 890-0705

Fax

(813) 890-0710

NPI assigned

Mar 21, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thriving LaneGroup PAC ID 1355741083, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Thriving Lane

  • Psychiatry Physician
  • Naples, FL
  • NPI 1376122515
  Medicare reassignment Care Compare group
• Inpatient Consultants of Florida, Inc

  • Internal Medicine Physician
  • Orange Park, FL
  • NPI 1396795597

  Physician Assistant

  Medicare reassignment NPD
• Florida Post Acute Medical Services 1 PA

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1255862439
  Medicare reassignment
• CS Pacs 3 Southeast, LLC

  • Hospitalist Physician
  • Bluefield, WV
  • NPI 1154104958

  FL

  Medicare reassignment
• Doctors R US Walk-in Clinic

  • Urgent Care Clinic/Center
  • Tampa, FL
  • NPI 1548395379
  NPD (past)
• Doctors R US Walk-in Clinic, Inc.

  • Multi-Specialty Clinic/Center
  • Tampa, FL
  • NPI 1427197250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1245356393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 W DR MLK BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076306",
            "telephone_number": "813-877-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6821 W HILLSBOROUGH AVE",
            "address_2": "STE #19",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336345003",
            "telephone_number": "813-890-0705",
            "fax_number": "813-890-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JOELLEN",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 2812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "PA 2812",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Gordon
• Charity J Gordon, APRN
• Cherie Gordon, ARNP
• Federico Gordon Jr., MBA, MLS(ASCP)
• Jessica Marie Gordon, ARNP
• Kevin B Gordon, ATC
• Kourtney Gordon, MS,RD/LD,CEDRD
• Madelynn Gordon
• Matthew Gordon, RPH
• Michelle Judith Gordon, MA CCC SLP

• Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.