Active NPI
Douglas Mark Gordon, D.C.
- Sports Physician Chiropractor
- Woodland Hills, CA
National Provider Identifier
1255409512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 23821
- Practice address
- 20700 Ventura Blvd.
Ste. 130
Woodland Hills, CA 91364-6277 - Phone
- (818) 345-2660
- Fax
- (818) 206-9471
- NPI assigned
- Dec 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 23821 | CA | Primary |
Addresses
Primary practice location
20700 Ventura Blvd.
Ste. 130
Woodland Hills, CA 91364-6277
Mailing address
20700 Ventura Blvd.
Ste. 130
Woodland Hills, CA 91364-6277
Phone (818) 345-2660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081112000179 | CA | Practitioner - Chiropractic | 1951460559 | Practice locations: Los Angeles, CA; Woodland Hills, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Cleveland Chiropractic College - Los Angeles, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
20700 Ventura Blvd
Ste. 130
Woodland Hills, CA 91364-6277
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404777600000",
"number": "1255409512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20700 VENTURA BLVD.",
"address_2": "STE. 130",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913646277",
"telephone_number": "818-345-2660",
"fax_number": "818-206-9471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20700 VENTURA BLVD.",
"address_2": "STE. 130",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913646277",
"telephone_number": "818-345-2660",
"fax_number": "818-206-9471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DOUGLAS",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-02",
"last_updated": "2014-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CA",
"license": "23821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodland Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.