Theodore G Gourdin, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

13033 Issued in SC

Practice address

1962 Charlie Hall Blvd
Charleston, SC 29414-5837

Phone

(843) 722-8000

Fax

(843) 647-6066

NPI assigned

Jun 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Gastroenterology

Education

Medical University of South Carolina College of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charleston Gastroenterology SpecialistsGroup PAC ID 3173437472, 49 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
• Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
• Roper Hospital Hospital, Charleston, SC, CCN 420087
• Trident Medical Center Hospital, Charleston, SC, CCN 420079
• Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Charleston Gastroenterology Specialists

  • Specialist
  • Charleston, SC
  • NPI 1205835865
  Medicare reassignment Care Compare group NPD
• Charleston Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Charleston, SC
  • NPI 1316946106
  Medicare reassignment NPD
• Summerville Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Summerville, SC
  • NPI 1578986550
  Medicare reassignment NPD
• Charleston Gastroenterology Specialists

  • Anesthesiology Physician
  • Charleston, SC
  • NPI 1194231761
  NPD

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

• Bon Secours St. Francis Xavier Hospital Inc.

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1851361778
  Care Compare affiliation
• Roper Hospital, Inc

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1962472860
  Care Compare affiliation
• Roper St Francis Hospital-Berkeley Inc.

  • General Acute Care Hospital
  • Summerville, SC
  • NPI 1336603646
  Care Compare affiliation
• Roper St. Francis Mount Pleasant Hospital

  • General Acute Care Hospital
  • Mt Pleasant, SC
  • NPI 1255645644
  Care Compare affiliation
• Trident Medical Center, LLC

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1366496937
  Care Compare affiliation

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1821094301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 2ND AVE STE 101",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867887",
            "telephone_number": "843-793-5182",
            "fax_number": "843-266-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145837",
            "telephone_number": "843-722-8000",
            "fax_number": "843-647-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURDIN",
        "first_name": "THEODORE",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "13033",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "13033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130334",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Gottfried, PHD
• Joanne Gottschall, RNC, CPM, LM
• Tammy Barnes Gottshalk, FNP-C
• Jameela Sherene Goudarzi, NURSE PRACTITIONER
• Jillian Gouin, PHARMD
• Theodore Stewart Gourdin, MD
• Larissa Gouvea Jose Felicio Da Costa, MD
• Christina Elizabeth Gover-O'Donnell, M.S., CDCES, RDN
• Katherine Elizabeth Govoni, RN
• Greer Gowen, RD

• Gastroenterology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.
• 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.