NPIMap

Individual provider Active NPI

Lemuel Durrell Gorden III, M.D.

  • Specialist
  • Montgomery, AL
National Provider Identifier
1285630905
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
22077 Issued in AL
Practice address
225B Winton M Blount Loop
Montgomery, AL 36117-3507
Phone
(334) 263-6228
Fax
(334) 265-9136
NPI assigned
Jun 27, 2005
Last updated
Mar 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 22077 AL Primary

Addresses

Primary practice location

225B Winton M Blount Loop
Montgomery, AL 36117-3507

Mailing address

225B Winton M Blount Loop
Montgomery, AL 36117-3507
Phone (334) 263-6228

Other identifiers 4

IdentifierTypeStateIssuer
051521812OtherALBCBS
G54042OtherALHEALTH SPRINGS
P00159247OtherGARAILROAD
009958605MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709001197 AL Practitioner - Pathology 3072591650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Tennessee, HSC, College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alabama Pathology AssociatesGroup PAC ID 8325026990, 3 clinicians

Practice addresses (Care Compare)

225 B Winton Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

225 B Winton M Blount Loop
Montgomery, AL 36117-3507

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22077ALMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Alabama Pathology Associates CurrentSince Jul 1, 2004 Accepting new patients
Alabama Pathology Associates Specialist CurrentSince Jul 1, 2004 Accepting new patients
Russell County Community Hospital LLC Past Accepting new patients
Laboratory Corporation of America Holdings Past Accepting new patients
Laboratory Corporation of America Holdings Past Accepting new patients

Locations

2019 Clubview St
Montgomery, AL 36106
Phone (334) 263-6228

225 Winton M Blount Loop
#B
Montgomery, AL 36117

225B Winton Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

225B Winton M Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1285630905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225B WINTON M BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-263-6228",
            "fax_number": "334-265-9136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225B WINTON M BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-263-6228",
            "fax_number": "334-265-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDEN",
        "first_name": "LEMUEL",
        "middle_name": "DURRELL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "22077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051521812",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH SPRINGS",
            "identifier": "G54042",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00159247",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009958605",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.