Johnathan Paul Gordon

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6386 Issued in OK

Practice address

109 N Fairland St
Pryor, OK 74361-4203

Phone

(918) 825-1405

Fax

(918) 876-3436

NPI assigned

Sep 10, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment NPD
• Grand Lake Mental Health Center, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Siloam Springs, OK
  • NPI 1205466372
  NPD
• Grand Lake Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1760965388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N FAIRLAND ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614203",
            "telephone_number": "918-825-1405",
            "fax_number": "918-876-3436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N FAIRLAND ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614203",
            "telephone_number": "918-825-1405",
            "fax_number": "918-876-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JOHNATHAN",
        "middle_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-10",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OK",
            "license": "6386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raegen S Gibson, M.S., CCC-SLP
• Michael Gerard Gietzen, DO
• Melissa Marie Girty, PTA
• Kali Michelle Goforth I, LPN
• Katherine Suzan Goins, PHARM D
• James Lawrence Gore, DDS
• Nicole Gorey, APRN
• Kristina D Graham
• Grand Lake Mental Health Center Inc
• Grand Lake Mental Health Center Inc.

• Social Worker in Pryor, OK
• Providers in Pryor, OK by specialty
• Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.

Verify at the official NPI Registry.