Randy Paul Gordon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1585 Issued in OK

Practice address

520 S Mustang Rd
Yukon, OK 73099-6737

Phone

(405) 749-7099

Fax

(405) 577-2032

NPI assigned

Jan 15, 2007

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 31, 2024 through Oct 31, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Vibrant Life Direct Care, PLLC

  • Primary Care Clinic/Center
  • Tuttle, OK
  • NPI 1730880212
  NPD (past)

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455753600000",
    "number": "1487705711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S MUSTANG RD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996737",
            "telephone_number": "405-749-7099",
            "fax_number": "405-577-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S MUSTANG RD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996737",
            "telephone_number": "405-749-7099",
            "fax_number": "405-577-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "RANDY",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2016-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200102980A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hunter Goodman, APRN, CNP
• Goodnight Moon Anesthesia PLLC
• Jamie Goodson, MA, LADC-MH-C
• Lauren Goodwin, R.N.
• Sierra Goodwin, APRN
• Veronica Gragg
• Robin Michelle Graham, PTA
• Jennifer Elaine Marie Gray
• Jerri Leigh Gray
• Green Mental Health PLLC

• Physician Assistant in Yukon, OK
• Providers in Yukon, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.