Individual provider Active NPI

Charles David Gordon, M.D.

  • Neurology Physician
  • Charlotte, NC
National Provider Identifier
1265525372
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2012-01542 Issued in NC
Practice address
6324 Fairview Rd Ste 400
Charlotte, NC 28210-4278
Phone
(980) 302-8626
Fax
(980) 302-8639
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 45189 AZ
Neurology Physician 2084N0400X 2012-01542 NC Primary

Addresses

Primary practice location

6324 Fairview Rd Ste 400
Charlotte, NC 28210-4278

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-9437

Other practice location 1

1918 Randolph Rd
Suite 400
Charlotte, NC 28207-1100
Phone (704) 384-9437

Other identifiers 2

IdentifierTypeStateIssuer
630053MedicaidAZ
5921444MedicaidNC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cgordon28955@direct.novanthealth.org
Direct Messaging Address cgordon28955@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120912000006 NC Practitioner - Internal MedicinePractitioner - Neurology 3678539244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Neurology
Education
Boston University School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Matrix Rehabilitation South Carolina, Inc.Group PAC ID 5799694568, shared by 2 NPIs, 21 clinicians

Practice addresses (Care Compare)

15033 Ballancroft Pkwy
Suite 200
Charlotte, NC 28277-4944
Phone (704) 316-2920

739 Galleria Blvd
Rock Hill, SC 29730-5785

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Sep 1, 2012 Accepting new patients
The Presbyterian Hospital Internal Medicine CurrentSince Feb 1, 2023 Accepting new patients
Novant Medical Group Inc Neurology CurrentSince Sep 1, 2012 Accepting new patients
The Presbyterian Hospital Internal Medicine CurrentSince Feb 1, 2023 Accepting new patients
The Presbyterian Hospital Internal Medicine Current Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Novant Health Medical Group, LLC Internal Medicine Past Accepting new patients

Locations

15033 Ballancroft Pkwy
Ste 200
Charlotte, NC 28277
Phone (704) 316-2920

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

6324 Fairview Rd
Ste 400
Charlotte, NC 28210
Phone (980) 302-8626

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 8

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 4

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1265525372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-9437",
            "fax_number": "704-384-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6324 FAIRVIEW RD STE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282104278",
            "telephone_number": "980-302-8626",
            "fax_number": "980-302-8639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1918 Randolph Rd",
            "address_2": "Suite 400",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071100",
            "country_code": "US",
            "telephone_number": "704-384-9437",
            "fax_number": "704-384-9440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CHARLES",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "45189",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2012-01542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630053",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921444",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgordon28955@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "6324 Fairview Rd Ste 400",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282104278",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgordon28955@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1918 Randolph Rd",
            "address_2": "Suite 400",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.