Active NPI
Ethan Benjamin Gordon, MD
- Family Medicine Physician
- Saginaw, MI
National Provider Identifier
1760227367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4351053528
- Practice address
- 1575 Concentric Blvd
Saginaw, MI 48604-9311 - Phone
- (989) 746-7766
- NPI assigned
- Jun 26, 2024
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4351053528 | MI | Primary |
Addresses
Primary practice location
1575 Concentric Blvd
Saginaw, MI 48604-9311
Mailing address
102 N Washington Ave Apt 503
Saginaw, MI 48607-1298
Phone (847) 707-0413
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240806000464 | MI | Order and Referring Only - Family Practice | 8527505783 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1760227367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 N WASHINGTON AVE APT 503",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486071298",
"telephone_number": "847-707-0413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 CONCENTRIC BLVD",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486049311",
"telephone_number": "989-746-7766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "ETHAN",
"middle_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-26",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4351053528",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.