Active NPI
Gordon Marvin Rick, DDS, MS
- Oral and Maxillofacial Pathology Dentistry
- San Diego, CA
National Provider Identifier
1679693550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 20041
- Practice address
- 5190 Governor Dr
Suite 106
San Diego, CA 92122-2847 - Phone
- (858) 784-0600
- Fax
- (858) 784-0604
- NPI assigned
- Apr 2, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 20041 | CA | Primary |
Addresses
Primary practice location
5190 Governor Dr
Suite 106
San Diego, CA 92122-2847
Mailing address
5190 Governor Dr
Suite 106
San Diego, CA 92122-2847
Phone (858) 784-0600
Other names 1
- Dr. Gordon Rick
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 15, 2014 through Jan 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Oral Pathology Service, LLC | Oral and Maxillofacial Pathology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Oral and Maxillofacial Pathology Dentistry
- San Diego, CA
- NPI 1487082046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1679693550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5190 GOVERNOR DR",
"address_2": "SUITE 106",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921222847",
"telephone_number": "858-784-0600",
"fax_number": "858-784-0604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5190 GOVERNOR DR",
"address_2": "SUITE 106",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921222847",
"telephone_number": "858-784-0600",
"fax_number": "858-784-0604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICK",
"first_name": "GORDON",
"middle_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "CA",
"license": "20041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GORDON",
"last_name": "RICK",
"prefix": "DR.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.