Individual provider Active NPI

Benjamin Stuart Gordon, PA-C

  • Medical Physician Assistant
  • Hemet, CA
National Provider Identifier
1821184078
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA17205 Issued in CA
Practice address
950 N State St
BLDG B, Suite D & E
Hemet, CA 92543-1485
Phone
(951) 765-1777
Fax
(951) 765-1772
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA17205 CA Primary

Addresses

Primary practice location

950 N State St
BLDG B, Suite D & E
Hemet, CA 92543-1485

Mailing address

27699 Jefferson Ave
Suite 300
Temecula, CA 92590-2661
Phone (951) 252-8588

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA17205CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients
Pediatric Partners Medical Professional Corporation Past Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821184078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE",
            "address_2": "SUITE 300",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902661",
            "telephone_number": "951-252-8588",
            "fax_number": "951-252-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 N STATE ST",
            "address_2": "BLDG B, SUITE D & E",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925431485",
            "telephone_number": "951-765-1777",
            "fax_number": "951-765-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "BENJAMIN",
        "middle_name": "STUART",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA17205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.