NPIMap

Individual provider Active NPI

Stephanie H Gordon, M.D.

  • Gynecology Physician
  • Conyers, GA
National Provider Identifier
1407849722
Registry record updated Aug 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
049382 Issued in GA
Practice address
2750 Owens Rd SW
Suite a
Conyers, GA 30094-3991
Phone
(678) 413-4644
Fax
(678) 413-4624
NPI assigned
Aug 23, 2005
Reactivated
Apr 7, 2006
Last updated
Aug 6, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 049382 GA Primary

Addresses

Primary practice location

2750 Owens Rd SW
Suite a
Conyers, GA 30094-3991

Mailing address

2750 Owens Rd SW
Suite a
Conyers, GA 30094-3991
Phone (678) 413-4644

Other identifiers 1

IdentifierTypeStateIssuer
551117710AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20080218000046 GA Practitioner - Obstetrics/Gynecology 6507898327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Mercer University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Womens Center PCGroup PAC ID 9931196516, 4 clinicians

Practice addresses (Care Compare)

140 Eagle Spring Court
Suite B
Stockbridge, GA 30281-6441

2750 Owens Dr
Suite a
Conyers, GA 30094

2750 Owens SW Rd
Suite a
Conyers, GA 30094
Phone (678) 413-4644

2750 Owens SW Rd
Suite a
Conyers, GA 30094-3991

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
33.72 of 100Reported as individual
Quality
25
Improvement activities
0
Cost
79.08

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
049382GAMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Womens Center PC Gynecology CurrentSince Sep 15, 2003 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Southern Crescent Womens Health Specialists at Eagle's Landing PastSince Aug 13, 2017 Accepting new patients

Locations

2750 Owens Rd SW
Conyers, GA 30094
Phone (678) 413-4644

2750 Owens Rd SW
Ste A
Conyers, GA 30094
Phone (678) 413-4644

140 Eagle Spring Ct
Ste B
Stockbridge, GA 30281
Phone (770) 302-0878

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12492/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344211200000",
    "number": "1407849722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 OWENS RD SW",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943991",
            "telephone_number": "678-413-4644",
            "fax_number": "678-413-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 OWENS RD SW",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943991",
            "telephone_number": "678-413-4644",
            "fax_number": "678-413-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "STEPHANIE",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-08-06",
        "deactivation_date": "2006-03-27",
        "reactivation_date": "2006-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "049382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "551117710A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.