Marilyn Gordon, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

81230 Issued in MA

Practice address

65 Libby St
Brockton, MA 02302-2992

Phone

(508) 584-6060

Fax

(508) 584-4949

NPI assigned

May 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

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.

• Brockton Pediatrics

  • Primary Care Clinic/Center
  • Brockton, MA
  • NPI 1629001904
  Medicare reassignment NPD
• Cape Cod Family Practice & Sports Medicine, P.C.

  • Family Medicine Physician
  • Mashpee, MA
  • NPI 1336346063
  NPD (past)
• Robert R Moore MD PHD PC

  • Internal Medicine Physician
  • N Falmouth, MA
  • NPI 1063619823
  NPD (past)
• Southeast Medical Group, P.C.

  dba North Atlanta Primary Care, P.C.

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1235296054
  NPD (past)

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1598716698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 LIBBY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022992",
            "telephone_number": "508-584-6060",
            "fax_number": "508-584-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 LIBBY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022992",
            "telephone_number": "508-584-6060",
            "fax_number": "508-584-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MARILYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "81230",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "81230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH",
            "identifier": "761592",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "65042",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3144500",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane K Goodrich, NP
• James Neil Goodrih, RN
• Emily Sarah Goodwin
• Alexandra Marie Gordon, ON CALL RECOVERY COA
• Asia Gordon, DDS
• Peter H Gordon, MD
• Rachel Gordon
• Amy Elizabeth Goren, PT, DPT
• Gerald R. Gorman, M.D.
• Andrea Gormley, R.N.

• Pediatrics Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; 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.

Verify at the official NPI Registry.