Active NPI
Bernard J. Gordon, MD
- Psychiatry Physician
- Portland, ME
National Provider Identifier
1609980515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD11839
- Practice address
- 145 Newbury St
Portland, ME 04101-4261 - Phone
- (207) 772-5400
- Fax
- (207) 772-5402
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD11839 | ME | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD11839 | ME |
Addresses
Primary practice location
145 Newbury St
Portland, ME 04101-4261
Mailing address
145 Newbury St
Portland, ME 04101-4261
Phone (207) 772-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022314 | Other | ME | ANTHEM BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD11839 | ME | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436745600000",
"number": "1609980515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 NEWBURY ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014261",
"telephone_number": "207-772-5400",
"fax_number": "207-772-5402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 NEWBURY ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014261",
"telephone_number": "207-772-5400",
"fax_number": "207-772-5402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "BERNARD",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2015-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ME",
"license": "MD11839",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "ME",
"license": "MD11839",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "022314",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.