NPIMap

Individual provider Active NPI

Berkman O. Gordon, MD

  • Emergency Medicine Physician
  • Ankeny, IA
National Provider Identifier
1619959269
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036.091223 Issued in IL
Practice address
1609 N Ankeny Blvd
200
Ankeny, IA 50023-4165
Phone
(404) 822-0871
NPI assigned
Nov 18, 2005
Last updated
Jun 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 37815 GA
Emergency Medicine Physician 207P00000X 036091223 IL
Emergency Medicine Physician 207P00000X 036.091223 IL Primary
Family Medicine Physician 207Q00000X 37815 GA
Nuclear Medicine Physician 207U00000X 37815 GA

Addresses

Primary practice location

1609 N Ankeny Blvd
200
Ankeny, IA 50023-4165

Mailing address

1609 N Ankeny Blvd
200
Ankeny, IA 50023-4165
Phone (404) 822-0871

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.091223ILMDEmergency Medicine Physician
37815GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McDonough County Hospital District Current Accepting new patients
McDonough County Hospital District Current Accepting new patients
McDonough County Hospital District Current Accepting new patients
McDonough County Hospital District Current Accepting new patients
McDonough County Hospital District Current Accepting new patients
Rend Emergency Physicians Emergency Medicine Past Accepting new patients
Adel Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Dodge Emergency Group LLC Emergency Medicine Past Accepting new patients
United Emergency Services, Inc. Emergency Medicine Past Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine Past Accepting new patients
McDonough County Hospital District Past Accepting new patients

Locations

525 E Grant St
Macomb, IL 61455
Phone (309) 836-1611

Interoperability endpoints

  • Direct secure messaging: bgordan@yourcarecommunity.org

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1619959269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 N ANKENY BLVD",
            "address_2": "200",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234165",
            "telephone_number": "404-822-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 N ANKENY BLVD",
            "address_2": "200",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234165",
            "telephone_number": "404-822-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "BERKMAN",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "37815",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036091223",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.091223",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "37815",
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "GA",
            "license": "37815",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.