Active NPI
Bruce L. Gordon, MD
- Emergency Medicine Physician
- Sacramento, CA
National Provider Identifier
1760590699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- C34270
- Practice address
- 2801 'L' Street
Sacramento, CA 95816 - Phone
- (916) 733-3003
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | C34270 | CA | Primary |
Addresses
Primary practice location
2801 'L' Street
Sacramento, CA 95816
Mailing address
P.O. Box 12020
Westminster, CA 92685-2020
Phone (888) 556-5617
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C342700 | Medicaid | CA |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C34270 | CA | MD | Emergency Medicine Physician |
| G34270 | CA | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America - California | Emergency Medicine | Current | Accepting new patients |
Locations
2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
Interoperability endpoints
- bgordonmd30061@hisp.ehr.sutterhealth.org
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.
-
- Emergency Medicine Physician
- San Francisco, CA
- NPI 1023063542
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254960000000",
"number": "1760590699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 12020",
"city": "WESTMINSTER",
"state": "CA",
"postal_code": "926852020",
"telephone_number": "888-556-5617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 'L' STREET",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95816",
"telephone_number": "916-733-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "BRUCE",
"middle_name": "L.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2009-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "C34270",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C342700",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; 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.