Individual provider Active NPI

Lindsay Gordon

  • Psychologist
  • Raleigh, NC
National Provider Identifier
1346779683
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5729 Issued in NC
Practice address
5121 Kingdom Way Ste 100
Raleigh, NC 27607-6063
Phone
(800) 442-2762
NPI assigned
Jun 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5729 NC Primary

Addresses

Primary practice location

5121 Kingdom Way Ste 100
Raleigh, NC 27607-6063

Mailing address

5121 Kingdom Way Ste 100
Raleigh, NC 27607-6063

Other practice location 1

505 Oberlin Rd Ste 230
Raleigh, NC 27605-1345
Phone (919) 743-0204

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5729NCMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Autism Society of North Carolina, Inc. PastSince Sep 20, 2020 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1346779683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5121 KINGDOM WAY STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5121 KINGDOM WAY STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076063",
            "telephone_number": "800-442-2762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 Oberlin Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276051345",
            "country_code": "US",
            "telephone_number": "919-743-0204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "LINDSAY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "5729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.