NPIMap

Individual provider Active NPI

Gordon G Cappelletty, PHD

  • Psychologist
  • Hickory, NC
National Provider Identifier
1689744336
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2520 Issued in NC
Practice address
1985 Tate Blvd SE
Suite 300
Hickory, NC 28602
Phone
(828) 326-5960
Fax
(828) 328-4729
NPI assigned
Nov 9, 2006
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2520 NC
Psychologist 103T00000X 2520 NC Primary
Clinical Psychologist 103TC0700X 2520 NC

Addresses

Primary practice location

1985 Tate Blvd SE
Suite 300
Hickory, NC 28602

Mailing address

1985 Tate Blvd SE
Suite 300
Hickory, NC 28602
Phone (828) 326-5960

Other identifiers 1

IdentifierTypeStateIssuer
6000558MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2520NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Counseling Past Accepting new patients
Crossroads Counseling Center, Inc. Psychologist Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gordon.cappelletty.336.0330166@crco.meditab.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1689744336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 TATE BLVD SE",
            "address_2": "SUITE 300",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "28602",
            "telephone_number": "828-326-5960",
            "fax_number": "828-328-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 TATE BLVD SE",
            "address_2": "SUITE 300",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "28602",
            "telephone_number": "828-326-5960",
            "fax_number": "828-328-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPPELLETTY",
        "first_name": "GORDON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "2520",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2520",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2520",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000558",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.