Gordon K. Ahlers II, MD
Individual provider Active NPI Family Medicine Physician · Morrisville, VT
NPI 1669490348 · NPPES record last updated Feb 13, 2020
Key facts
- NPI
- 1669490348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 042.0006927 (VT)
- Practice address
- 609 Washington Hwy
Morrisville, VT 05661-8652 - Phone
- (802) 888-5639
- Fax
- (802) 888-6040
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171215001902 | CA | Practitioner - Family Practice | 5092602540 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48027511205 | UT | MD | Emergency Medicine Physician |
| G89199 | CA | MD | Family Medicine Physician |
| 042.0006927 | VT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients |
Locations
1275 8th St
Arcata, CA 95521
670 9th St
Ste 203
McKinleyville, CA 95521
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 48027511205 | UT | |
| Emergency Medicine Physician | 207P00000X | 48027511205 | UT | |
| Family Medicine Physician | 207Q00000X | G89199 | CA | |
| Family Medicine Physician | 207Q00000X | 042.0006927 | VT | Yes |
Addresses
Primary practice location
609 Washington Hwy
Morrisville, VT 05661-8652
Mailing address
PO Box 749
Morrisville, VT 05661-0749
Phone (802) 888-5639
Other practice location 1
516 East Nizhoni Blvd.
Gallup, NM 87301-1337
Phone (505) 722-1000
Other practice location 2
38883 Hwy 299
Willow Creek, CA 95573-0726
Phone (503) 629-1941
Other providers in Morrisville, VT
- Marc William Adams
- Rebecca J Ainsworth
- Zach Akey
- Meghan A. Albrecht
- Amy Albright
- Hannah Cordes Allen
All providers in Morrisville, VT · Family Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.