Active NPI
Tracy L Gordon
- Contractor
- Fairfield, OH
National Provider Identifier
1740688241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 2850937
- Practice address
- 3316 Woodside Dr
Fairfield, OH 45014-5023 - Phone
- (513) 218-7996
- Fax
- (513) 860-0341
- NPI assigned
- Dec 15, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 2850937 | OH | Primary |
Addresses
Primary practice location
3316 Woodside Dr
Fairfield, OH 45014-5023
Mailing address
3316 Woodside Dr
Fairfield, OH 45014-5023
Phone (513) 218-7996
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2850937 | OH | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418601600000",
"number": "1740688241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3316 WOODSIDE DR",
"city": "FAIRFIELD",
"state": "OH",
"postal_code": "450145023",
"telephone_number": "513-218-7996",
"fax_number": "513-860-0341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3316 WOODSIDE DR",
"city": "FAIRFIELD",
"state": "OH",
"postal_code": "450145023",
"telephone_number": "513-218-7996",
"fax_number": "513-860-0341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "TRACY",
"middle_name": "L",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-15",
"last_updated": "2014-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OH",
"license": "2850937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.