NPIMap

Individual provider Active NPI

Leah Macke Gordon, M.D.

  • Internal Medicine Physician
  • Missoula, MT
National Provider Identifier
1679849640
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD50662894 Issued in WA
Practice address
401 Railroad St W
Missoula, MT 59802-4109
Phone
(406) 258-4789
NPI assigned
Mar 23, 2012
Last updated
Nov 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MED-PHYS-LIC-102284 MT
Internal Medicine Physician 207R00000X MD50662894 WA Primary

Addresses

Primary practice location

401 Railroad St W
Missoula, MT 59802-4109

Mailing address

401 Railroad St W
Missoula, MT 59802-4109
Phone (406) 258-4789

Other identifiers 1

IdentifierTypeStateIssuer
1679849640MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20211111000616 MT Practitioner - Internal Medicine 5395066534 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Partnership Health Center IncGroup PAC ID 6103843479, 51 clinicians

Practice addresses (Care Compare)

323 W Alder St
Missoula, MT 59802-4123
Phone (406) 258-4789

401 Railroad St W
Missoula, MT 59802-4178
Phone (406) 258-4789

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-102284MTMDInternal Medicine Physician
MD50662894WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Partnership Health Center Inc Current Accepting new patients
Partnership Health Center Inc CurrentSince Nov 1, 2021 Accepting new patients
Partnership Health Center Inc CurrentSince Nov 1, 2021 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1110 W Broadway St
Missoula, MT 59802
Phone (406) 728-1809

323 W Alder St
Missoula, MT 59802
Phone (406) 258-4195

401 Railroad St W
Missoula, MT 59802
Phone (406) 258-4183

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 6

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": "1332460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1679849640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 RAILROAD ST W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024109",
            "telephone_number": "406-258-4789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 RAILROAD ST W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024109",
            "telephone_number": "406-258-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "LEAH",
        "middle_name": "MACKE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-23",
        "last_updated": "2021-11-02",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-102284",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD50662894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679849640",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.