Vicki R Gordon, MD PHD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C127825 Issued in CA

Practice address

550 E Washington Blvd
Crescent City, CA 95531-8160

Phone

(707) 496-5465

NPI assigned

Jul 18, 2006

Last updated

Apr 20, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Internal Medicine

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Golden Valley Health CentersGroup PAC ID 4183527187, 114 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vgordon24564@epiclp.direct-ci.com

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.

• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753
  Medicare reassignment Care Compare group NPD
• Regents of the University of California

  dba UC Davis Medical Group

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1952998973
  Medicare reassignment NPD
• County of Los Angeles

  dba Martin Luther King, Jr. Outpatient Center

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1780877613
  Medicare reassignment
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Manteca, CA
  • NPI 1477020121
  NPD
• Golden Valley Health Centers

  dba GVHC Pharmacy

  • Community/Retail Pharmacy
  • Merced, CA
  • NPI 1093817405
  NPD
• Regents of the University of California

  • Multi-Specialty Clinic/Center
  • Elk Grove, CA
  • NPI 1083694616
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1487867503
  NPD (past)
• Essent PRMC LP

  dba Paris Regional Medical Center

  • Certified Registered Nurse Anesthetist
  • Paris, TX
  • NPI 1376541839
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1881613396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4182 W BROADWAY APT B",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902504092",
            "telephone_number": "310-956-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318160",
            "telephone_number": "707-496-5465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "644 E REGENT ST",
            "address_2": "STE 105",
            "address_purpose": "LOCATION",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011443",
            "country_code": "US",
            "telephone_number": "310-644-5055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "VICKI",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301083013",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "127825",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C127825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN NUMBER",
            "identifier": "149719",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Helen Godwyn, RD CDE
• Dulce Rafaela Gomez
• Maria Raquel Gonzales-Flores
• David Gonzales
• Kenyetta Michelle Gordon, MD
• John Michael Goss, P.T.
• Gray Chiropractic PC
• Sean Gray, D.C.
• Holly Greene
• Brian Randall Greenough, PHARM.D.

• Internal Medicine Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.