Active NPI
Jacob Gordon
- Child Intellectual and/or Developmental Disabilities Respite Care
- Columbus, OH
National Provider Identifier
1619793015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Intellectual and/or Developmental Disabilities Respite Care
- Practice address
- 1656 Canvasback LN
Columbus, OH 43215-7023 - Phone
- (419) 270-6893
- NPI assigned
- Dec 2, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | UR685742 | OH | |
| Private Vehicle | 347C00000X | UR685742 | OH | |
| Child Intellectual and/or Developmental Disabilities Respite Care | 385HR2060X | Primary |
Addresses
Primary practice location
1656 Canvasback LN
Columbus, OH 43215-7023
Mailing address
1656 Canvasback LN
Columbus, OH 43215-7023
Phone (419) 270-6893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| UR685742 | OH | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1619793015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1656 CANVASBACK LN",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432157023",
"telephone_number": "419-270-6893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1656 CANVASBACK LN",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432157023",
"telephone_number": "419-270-6893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-02",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "OH",
"license": "UR685742",
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "OH",
"license": "UR685742",
"primary": false
},
{
"code": "385HR2060X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.