Individual provider Active NPI

Andrew James Gordon, MD

  • Surgery Physician
  • Holly Springs, NC
National Provider Identifier
1629496054
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2024-02426 Issued in NC
Practice address
781 Avent Ferry Rd Ste 214
Holly Springs, NC 27540-7776
Phone
(919) 784-7874
Fax
(919) 784-2708
NPI assigned
Apr 2, 2014
Last updated
Dec 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2024-02426 NC Primary
Surgery Physician 208600000X 0101266662 VA
Surgery Physician 208600000X 291190 MA

Addresses

Primary practice location

781 Avent Ferry Rd Ste 214
Holly Springs, NC 27540-7776

Mailing address

781 Avent Ferry Rd Ste 214
Holly Springs, NC 27540-7776
Phone (919) 784-7874

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address agordon1198307@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190913001364 VA Practitioner - General Surgery 9335478544 Reassigns benefits to 1 organization
I20241210004234 NC Practitioner - General Surgery 9335478544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tufts University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

781 Avent Ferry Rd
Suite 214
Holly Springs, NC 27540-7776
Phone (919) 784-1410

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
291190MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina MG, LLC Surgery CurrentSince Jun 1, 2025 Accepting new patients
Fauquier Physician Practices LLC Surgery CurrentSince Jun 16, 2021 Accepting new patients
Northern Virginia Surgical Specialists LTD Surgery CurrentSince Sep 1, 2019 Accepting new patients
Rex Hospital Inc Past Accepting new patients

Locations

1505 SW Cary Pkwy
Ste 302
Cary, NC 27511
Phone (919) 367-2580

781 Avent Ferry Rd
Ste 214
Holly Springs, NC 27540
Phone (919) 567-6133

850 S Main St
Holly Springs, NC 27540
Phone (919) 784-7093

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

1100 Sunset Ln
Ste 1211A
Culpeper, VA 22701
Phone (540) 316-5950

8650 Sudley Rd
Ste 206
Manassas, VA 20110
Phone (703) 368-9234

432 Hospital Dr
Warrenton, VA 20186
Phone (540) 347-2805

550 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5940

Interoperability endpoints

  • Direct secure messaging: agordon1198307@direct.unc.nchie.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1629496054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 AVENT FERRY RD STE 214",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275407776",
            "telephone_number": "919-784-7874",
            "fax_number": "919-784-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 AVENT FERRY RD STE 214",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275407776",
            "telephone_number": "919-784-7874",
            "fax_number": "919-784-2708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ANDREW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2024-02426",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101266662",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "291190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agordon1198307@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "781 Avent Ferry Rd Ste 214",
            "city": "Holly Springs",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275407776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holly Springs, NC

Sources for this page

Verify at the official NPI Registry.