Active NPI
Gordon Tadewaldt, MD
- Anesthesiology Physician
- Yreka, CA
National Provider Identifier
1821092735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- G78660
- Practice address
- 444 Bruce St
Yreka, CA 96097-3450 - Phone
- (530) 842-7297
- Fax
- (530) 842-9054
- NPI assigned
- Jun 8, 2005
- Last updated
- Jul 13, 2026
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | G78660 | CA | Primary |
Addresses
Primary practice location
444 Bruce St
Yreka, CA 96097-3450
Mailing address
PO Box 1206
Yreka, CA 96097-1206
Phone (530) 842-7297
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G786600 | Medicaid | CA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G78660 | CA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mount Shasta Radiology Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Diagnostic Radiology Physician
- Mount Shasta, CA
- NPI 1568431278
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1821092735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1206",
"city": "YREKA",
"state": "CA",
"postal_code": "960971206",
"telephone_number": "530-842-7297",
"fax_number": "530-842-9054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 BRUCE ST",
"city": "YREKA",
"state": "CA",
"postal_code": "960973450",
"telephone_number": "530-842-7297",
"fax_number": "530-842-9054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADEWALDT",
"first_name": "GORDON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-08",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "G78660",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G786600",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yreka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.