NPIMap

Individual provider Active NPI

Kenneth D Gordon, MD

  • Internal Medicine Physician
  • Lagrange, GA
National Provider Identifier
1871549204
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
037816 Issued in GA
Practice address
1602 Vernon Rd
Suite 400
Lagrange, GA 30240-4100
Phone
(706) 882-9341
Fax
(706) 884-0131
NPI assigned
May 26, 2006
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 037816 GA Primary

Addresses

Primary practice location

1602 Vernon Rd
Suite 400
Lagrange, GA 30240-4100

Mailing address

1602 Vernon Rd
Suite 400
Lagrange, GA 30240-4100
Phone (706) 882-9341

Other identifiers 1

IdentifierTypeStateIssuer
100064937AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lagrangeinternalmedicine@1300.direct.myezyaccess.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051207000658 GA Practitioner - Internal Medicine 8527089440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Tulane University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lagrange Internal Medicine, PCGroup PAC ID 4183663750, 8 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1602 Vernon Rd
Suite 400
Lagrange, GA 30240-4129
Phone (706) 882-9341

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: kenneth.gordon@gadirect.net
  • Direct secure messaging: kenneth.gordon@lim.gadirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1871549204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 VERNON RD",
            "address_2": "SUITE 400",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404100",
            "telephone_number": "706-882-9341",
            "fax_number": "706-884-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 VERNON RD",
            "address_2": "SUITE 400",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404100",
            "telephone_number": "706-882-9341",
            "fax_number": "706-884-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KENNETH",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "037816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100064937A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lagrangeinternalmedicine@1300.direct.myezyaccess.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1602 Vernon Rd",
            "address_2": "Suite 400",
            "city": "Lagrange",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302404100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

Verify at the official NPI Registry.