NPIMap

Individual provider Active NPI

Andrew Robert Gordon, M.D.

  • Internal Medicine Physician
  • Jenks, OK
National Provider Identifier
1447228549
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18079 Issued in OK
Practice address
220 S Elm St Ste 200
Jenks, OK 74037-3701
Phone
(918) 403-7144
Fax
(918) 856-5561
NPI assigned
Mar 14, 2006
Last updated
Oct 1, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18079 OK Primary

Addresses

Primary practice location

220 S Elm St Ste 200
Jenks, OK 74037-3701

Mailing address

1923 S Utica
Credentialing, Ground FL
Tulsa, OK 74104-6520
Phone (918) 403-7144

Other identifiers 1

IdentifierTypeStateIssuer
100113490AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20100225000124 OK Practitioner - Internal Medicine 5496899692 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Omni Medical Group IncGroup PAC ID 9739080490, 82 clinicians

Practice addresses (Care Compare)

1919 S Wheeling Ave
Suite 200
Tulsa, OK 74104-5631
Phone (918) 748-7600

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2967

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18079OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Apr 1, 2012 Accepting new patients
Omni Medical Group Inc Internal Medicine CurrentSince Aug 1, 1995 Accepting new patients
St. John Physicians, Inc. Internal Medicine CurrentSince Apr 1, 2012 Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1919 S Wheeling Ave
Ste 404
Tulsa, OK 74104
Phone (918) 748-7520

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

Organizations & group practices 4

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 8

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1447228549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA",
            "address_2": "CREDENTIALING, GROUND FL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-403-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S ELM ST STE 200",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373701",
            "telephone_number": "918-403-7144",
            "fax_number": "918-856-5561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ANDREW",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2026-10-01",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "18079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100113490A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jenks, OK

Sources for this page

Verify at the official NPI Registry.