NPIMap

Individual provider Active NPI

Jeffery D Gordon, M.D.

  • Diagnostic Radiology Physician
  • West Plains, MO
National Provider Identifier
1477531838
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
45986 Issued in MN
Practice address
1100 N Kentucky Ave
West Plains, MO 65775-2029
Phone
(417) 257-6713
Fax
(417) 257-5878
NPI assigned
Jan 5, 2006
Last updated
Sep 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 45986 MN
Diagnostic Radiology Physician 2085R0202X 2017001081 MO
Diagnostic Radiology Physician 2085R0202X 45986 MN Primary

Addresses

Primary practice location

1100 N Kentucky Ave
West Plains, MO 65775-2029

Mailing address

PO Box 1100
West Plains, MO 65775-1100
Phone (417) 256-9111

Other practice location 1

3102 Independence Sq
West Plains, MO 65775-4235
Phone (417) 257-7451

Other identifiers 3

IdentifierTypeStateIssuer
1477531838MedicaidMO
218633001MedicaidAR
098444200MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20170220002350 MO Practitioner - Diagnostic Radiology 9931006277 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Mississippi School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozarks Medical CenterGroup PAC ID 3870491863, 166 clinicians

Practice addresses (Care Compare)

1100 N Kentucky Ave
West Plains, MO 65775-2029

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as group
Quality
78.58
Promoting interoperability
99
Improvement activities
40
Cost
77.82

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45986MNMDDiagnostic Radiology Physician
2017001081MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center CurrentSince Sep 23, 2024 Accepting new patients
Mayo Clinic Past Accepting new patients
Consulting Radiologists, LTD Neuroradiology Past Accepting new patients
Quest Diagnostics LLC Il Past Accepting new patients
Noran Neurological Clinic P.a. PastSince Sep 17, 2023 Accepting new patients
Comprehensive Radiology Services, PLLC Diagnostic Radiology PastSince Mar 8, 2001 Accepting new patients

Locations

1100 N Kentucky Ave
West Plains, MO 65775
Phone (417) 257-5959

Interoperability endpoints

  • Direct secure messaging: dr.gordon@mhccaremail.com

Organizations & group practices 7

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 1

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": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1477531838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1100",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657751100",
            "telephone_number": "417-256-9111",
            "fax_number": "417-257-5947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752029",
            "telephone_number": "417-257-6713",
            "fax_number": "417-257-5878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3102 Independence Sq",
            "address_purpose": "LOCATION",
            "city": "West Plains",
            "state": "MO",
            "postal_code": "657754235",
            "country_code": "US",
            "telephone_number": "417-257-7451",
            "fax_number": "417-256-9277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JEFFERY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MN",
            "license": "45986",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2017001081",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "45986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477531838",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218633001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "098444200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Plains, MO

Sources for this page

Verify at the official NPI Registry.