Evan Ross Gordon-Wollin, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20A16019 Issued in CA

Practice address

1426 Montana Ave Ste 2
Santa Monica, CA 90403-1763

Phone

(310) 388-6798

NPI assigned

May 5, 2016

Last updated

Jun 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Internal Medicine

Education

Western University of Health Sciences College of Dental Med, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kansal IncGroup PAC ID 6406089739, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• First Smile Home Health Care Home health agency, Burbank, CA, CCN 059138
• Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625
• Cedar-Sinai Marina del Rey Hospital Hospital, Marina del Rey, CA, CCN 050740

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evan Gordon-Wollin DO

  • Internal Medicine Physician
  • West Hollywood, CA
  • NPI 1710747175
  Medicare reassignment NPD Authorized official
• Kansal Inc

  dba Platinum Medical Group

  • Internal Medicine Physician
  • West Hollywood, CA
  • NPI 1043510183
  Medicare reassignment Care Compare group NPD
• Inpatient Specialists of California, PC

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1952792475
  Medicare reassignment NPD

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

• Cedars-Sinai Marina Hospital

  dba Cedars-Sinai Marina Del Rey Hospital

  • General Acute Care Hospital
  • Marina del Rey, CA
  • NPI 1942269725
  Care Compare affiliation
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  Care Compare affiliation
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • West Hollywood, CA
  • NPI 1891940326
  Care Compare affiliation
• First Smile Home Health Care Inc

  • Home Health Agency
  • Burbank, CA
  • NPI 1306011507
  Care Compare affiliation

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1548616873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69446",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900690446",
            "telephone_number": "310-388-6798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1426 MONTANA AVE STE 2",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904031763",
            "telephone_number": "310-388-6798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON-WOLLIN",
        "first_name": "EVAN",
        "middle_name": "ROSS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-05",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A16019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Goodrich
• Leslie Goodwin
• Clarissa A Gooze, FNP
• Natasha Gorby, OTR/L
• Gordon Averill, DMD and Angie Dunkling, DMD Dental Services Inc (26th Street Dental)
• Alan T Gordon, LCSW
• Bruce R. Gordon, PH.D.
• Claire Gordon
• Earl Mark Gordon, M.D.
• Edward Francis Gordon, L.AC.

• Internal Medicine Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; 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.