Active NPI
Vicki L Gorder, PA-C
- Physician Assistant
- Grand Forks, ND
National Provider Identifier
1467543470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PAC0156
- Practice address
- 1380 S Columbia Rd
Grand Forks, ND 58201-4059 - Phone
- (701) 795-2000
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PAC0156 | ND | Primary |
Addresses
Primary practice location
1380 S Columbia Rd
Grand Forks, ND 58201-4059
Mailing address
2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vgorder4154@direct.directaltru.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100419000191 | ND | Practitioner - Physician Assistant | 0143357434 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAC0156 | ND | MD | Physician Assistant |
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": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603065600000",
"number": "1467543470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 DEMERS AVE",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58201",
"telephone_number": "701-780-1891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1380 S COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014059",
"telephone_number": "701-795-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDER",
"first_name": "VICKI",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2020-10-19",
"certification_date": "2020-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ND",
"license": "PAC0156",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vgorder4154@direct.directaltru.org",
"affiliation": "N",
"endpointDescription": "Direct mail",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1380 S Columbia Rd",
"city": "Grand Forks",
"state": "ND",
"country_code": "US",
"postal_code": "582014059",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.