Active NPI
David S Gordon, MD
- Hematology & Oncology Physician
- Traverse City, MI
National Provider Identifier
1477519940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 4301079204
- Practice address
- 217 S Madison Street
Traverse City, MI 49684-2320 - Phone
- (231) 392-8400
- Fax
- (231) 935-7888
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 4301079204 | MI | Primary |
Addresses
Primary practice location
217 S Madison Street
Traverse City, MI 49684-2320
Mailing address
2513 Momentum PL
Chicago, IL 60689-5325
Phone (231) 935-6080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4388739 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mmcmedonc@mhc.direct.varian.com |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615852800000",
"number": "1477519940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2513 MOMENTUM PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606895325",
"telephone_number": "231-935-6080",
"fax_number": "231-935-6081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 S MADISON STREET",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842320",
"telephone_number": "231-392-8400",
"fax_number": "231-935-7888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DAVID",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2021-03-16",
"certification_date": "2021-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "MI",
"license": "4301079204",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4388739",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mmcmedonc@mhc.direct.varian.com",
"affiliation": "N",
"address_1": "217 S madison Street",
"city": "Traverse City",
"state": "MI",
"country_code": "US",
"postal_code": "496842320",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.