Amanda B Gordon, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2017007862 Issued in MO

Practice address

30 Ronnies PLZ
Saint Louis, MO 63126-3552

Phone

(314) 989-6807

NPI assigned

Sep 15, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Amanda B Darden Former name

Electronic endpoints 4

Medicare fee-for-service enrollment

Enrolled in MO, IL, WI, OK4 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 4

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

SSM Health Care St LouisGroup PAC ID 7810800737, 171 clinicians

SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agordon29894@direct-ehr-ssmhc.com

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.

• SSM Health Care St Louis

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment Care Compare group NPD
• Dean Health Systems, Inc

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment Care Compare group NPD
• SSM Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207
  Medicare reassignment Care Compare group
• Emergency Physicians of St. Luke'S, LLC

  • Emergency Medicine Physician
  • Chesterfield, MO
  • NPI 1215359815

  Nurse Practitioner

  Medicare reassignment NPD
• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment NPD
• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment NPD
• Saints Medical Group, LLC

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1437195922
  Medicare reassignment NPD
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Louis, MO
  • NPI 1366400855
  NPD
• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991
  NPD
• Dean Health Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD
• Saints Medical Group, LLC

  • Durable Medical Equipment & Medical Supplies
  • Edmond, OK
  • NPI 1730907700
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Fenton, MO
  • NPI 1851496152
  Care Compare affiliation

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1780103143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 RONNIES PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631263552",
            "telephone_number": "314-989-6807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1718 Catlin Dr",
            "address_purpose": "LOCATION",
            "city": "Barnhart",
            "state": "MO",
            "postal_code": "630121277",
            "country_code": "US",
            "telephone_number": "844-766-7200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1821 S Stoughton Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537162257",
            "country_code": "US",
            "telephone_number": "314-989-6807",
            "fax_number": "314-989-2940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "AMANDA",
        "middle_name": "B",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-15",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "14987",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017007862",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2017007862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780103143",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agordon29894@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "agordon29894@direct-ehr-ssmhc.com",
            "address_1": "30 Ronnies Plz",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631263552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "30 Ronnies Plz",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631263552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agordon29894@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "agordon29894@direct-ehr-ssmhc.com",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "DARDEN",
            "middle_name": "B",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Parul Gor, M.D.
• David A Goran, MD
• John Gorcsan III, MD
• Gordon Counseling and Consulting, LLC
• Jodie Gordon-Bertish
• Andrea Thomas Gordon, D.D.S.
• Ashley Gordon
• Brittney Imani Gordon
• Delores Gordon
• Diana L Gordon, COTA

• Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.