Kimberly Renee Gordon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-07737 Issued in NC

Practice address

9929 Rea Rd Ste 201
Waxhaw, NC 28173-6439

Phone

(704) 316-1650

Fax

(704) 316-1651

NPI assigned

Feb 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in FL, NC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2007

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

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.

• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment Care Compare group
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Medical Group, Inc

  • Psychiatry Physician
  • Matthews, NC
  • NPI 1952842833
  NPD
• Novant Health Medical Group, LLC

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1134841802
  NPD (past)

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

{
    "created_epoch": "1266624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1346562147",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9929 REA RD STE 201",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736439",
            "telephone_number": "704-316-1650",
            "fax_number": "704-316-1651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3131 N McMullen Booth Rd",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337612008",
            "country_code": "US",
            "telephone_number": "727-726-8871",
            "fax_number": "727-726-8571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9623 Redstone Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Indian Land",
            "state": "SC",
            "postal_code": "29707",
            "country_code": "US",
            "telephone_number": "803-615-0880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Matthews Township Pkwy Ste 320",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281055403",
            "country_code": "US",
            "telephone_number": "704-384-1261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KIMBERLY",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-20",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105103",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018579700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y0S1D",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgordon715664@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "3131 N McMullen Booth Rd",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337612008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgordon715664@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "9929 Rea Rd Ste 201",
            "city": "Waxhaw",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281736439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wendy Goldstein
• Jennifer Lynn Gonzales, PA
• Anyha Janae Goode
• Lauren Goodin
• Stephanie Goodson, MS, LPA
• Donna Gray-Van Buren
• Aina Malika Veronica Greene, LCMHC
• Giles Ronald Greenwood
• Sheryl Griffith
• Antoinette Gunthner, PT

• Physician Assistant in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.