Active NPI
Mark R. Gordon, M.D.
- Urology Physician
- St Petersburg, FL
National Provider Identifier
1275528887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- ME20691
- Practice address
- 620 10TH Street N.
St Petersburg, FL 33705-1407 - Phone
- (727) 824-7146
- Fax
- (727) 824-7119
- NPI assigned
- Sep 20, 2005
- Last updated
- Mar 31, 2014
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | ME20691 | FL | Primary |
Addresses
Primary practice location
620 10TH Street N.
St Petersburg, FL 33705-1407
Mailing address
PO Box 12868
St Petersburg, FL 33733-2868
Phone (727) 532-1355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 058923300 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20691 | FL | MD | Dentist |
| ME20691 | FL | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suncoast Medical Clinic LLC | Past | Accepting new patients | |
| Suncoast Medical Clinic LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Medical Laboratory
- St Petersburg, FL
- NPI 1649397662
-
- Durable Medical Equipment & Medical Supplies
- St Petersburg, FL
- NPI 1760664882
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396224000000",
"number": "1275528887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12868",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337332868",
"telephone_number": "727-532-1355",
"fax_number": "727-266-4928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 10TH STREET N.",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337051407",
"telephone_number": "727-824-7146",
"fax_number": "727-824-7119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MARK",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2014-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "FL",
"license": "ME20691",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "058923300",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.