Gordon Thomas Fahey Jr., MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A78020 Issued in CA

Practice address

999 S Fairmont Ave
Suite 100
Lodi, CA 95240-5100

Phone

(209) 334-2010

Fax

(209) 334-0132

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

Medical College of Georgia School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marshall Medical CenterGroup PAC ID 7517875859, 168 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshall Medical Center Hospital, Placerville, CA, CCN 050254

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Marshall Medical Center

  • Family Medicine Physician
  • El Dorado Hills, CA
  • NPI 1114727377
  Medicare reassignment Care Compare group NPD
• Adventist Health Physicians Network

  • Multi-Specialty Clinic/Center
  • Hanford, CA
  • NPI 1063718583
  Medicare reassignment NPD
• Adventist Health Physicians Network

  • Physical Therapy Clinic/Center
  • Paradise, CA
  • NPI 1134092190
  NPD
• Adventist Health Physicians Network

  • Surgery Physician
  • Lodi, CA
  • NPI 1780033084
  NPD
• Marshall Medical Center

  • Obstetrics Physician
  • Placerville, CA
  • NPI 1609062389
  NPD
• Lodi Memorial Hospital Association Inc

  • Rehabilitation Hospital Unit
  • Lodi, CA
  • NPI 1821028671
  NPD (past)
• Marshall Medical Center

  • Interventional Cardiology Physician
  • Placerville, CA
  • NPI 1215181664
  NPD (past)
• Trinity Plaza Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
  • NPI 1073758264
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Marshall Medical Center

  • General Acute Care Hospital
  • Placerville, CA
  • NPI 1972503142
  Care Compare affiliation

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1457323446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "SUITE 100",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405100",
            "telephone_number": "209-334-2010",
            "fax_number": "209-334-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "SUITE 100",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405100",
            "telephone_number": "209-334-2010",
            "fax_number": "209-334-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "GORDON",
        "middle_name": "THOMAS",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A78020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0102080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Pharmaceutical of California, LLC
• Excel Rehab Physical Therapy Inc
• Express Ways Logistics
• Rhonda Eyzaguirre, PHD, LEP, NCSP
• Ezell Askew MD Inc
• Fairmont Dermatology Medical Associates Inc
• Fairmont Pharmacy
• Fairmont Pharmacy
• Fairmont Pharmacy
• Fairway Transportation, Inc

• Surgery Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; 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.