NPIMap

Individual provider Active NPI

Carlene Gordon

  • Family Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1649529025
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024170186 Issued in VA
Practice address
125 Olde Greenwich Drive
Suite 220
Fredericksburg, VA 22408-4010
Phone
(540) 898-8001
Fax
(540) 898-2127
NPI assigned
Aug 31, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024170186 VA Primary

Addresses

Primary practice location

125 Olde Greenwich Drive
Suite 220
Fredericksburg, VA 22408-4010

Mailing address

121 Courthouse LN
Bowling Green, VA 22427-9336
Phone (804) 633-5840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140701001766 VA Practitioner - Nurse Practitioner 4284859463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mary Washington Healthcare PhysiciansGroup PAC ID 2769546530, 286 clinicians

Practice addresses (Care Compare)

121 Courthouse LN
Bowling Green, VA 22427-9336
Phone (804) 633-5840

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Midlothian, VA, CCN 497538
  • At Home Care Home health agency, Mechanicsvlle, VA, CCN 497493
  • Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022
  • Stafford Hospital, LLC Hospital, Stafford, VA, CCN 490140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024170186VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Washington Healthcare Physicians CurrentSince May 13, 2019 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince May 13, 2019 Accepting new patients
Pathology Associates of Fredericksburg PTR Current Accepting new patients

Locations

121 Courthouse Ln
Bowling Green, VA 22427
Phone (804) 633-1232

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

16463 Dahlgren Rd
King George, VA 22485
Phone (540) 644-9505

Interoperability endpoints

  • Direct secure messaging: cgordon37702@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1649529025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 COURTHOUSE LN",
            "city": "BOWLING GREEN",
            "state": "VA",
            "postal_code": "224279336",
            "telephone_number": "804-633-5840",
            "fax_number": "804-633-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 OLDE GREENWICH DRIVE",
            "address_2": "SUITE 220",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224084010",
            "telephone_number": "540-898-8001",
            "fax_number": "540-898-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CARLENE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-31",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024170186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.