Active NPI
Michael A Gordon, MD
- Surgery Physician
- Sanford, NC
National Provider Identifier
1902885908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 13991
- Practice address
- 117 Dennis Drive
Sanford, NC 27330 - Phone
- (919) 774-2220
- NPI assigned
- Jan 10, 2006
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 13991 | NC | Primary |
| Vascular Surgery Physician | 2086S0129X | 13991 | NC |
Addresses
Primary practice location
117 Dennis Drive
Sanford, NC 27330
Mailing address
117 Dennis Drive
Sanford, NC 27330
Phone (919) 774-2220
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0170C | Other | BCBS | |
| 8936308 | Medicaid | NC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DLP Frye Medical Group LLC | 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.
-
dba FryeCare Family Medicine Watauga
- Family Medicine Physician
- Boone, NC
- NPI 1083152961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1902885908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 DENNIS DRIVE",
"city": "SANFORD",
"state": "NC",
"postal_code": "27330",
"telephone_number": "919-774-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 DENNIS DRIVE",
"city": "SANFORD",
"state": "NC",
"postal_code": "27330",
"telephone_number": "919-774-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "13991",
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NC",
"license": "13991",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0170C",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8936308",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sanford, NC
- Yolanda Taylor Goldston, LCSW
- Melissa Ivette Golzio
- Lori B Gooch, RDN
- Good Spirits
- Samantha Lynn Gooden, LPCA
- Samantha Gordon, PA
- Goshen Medical Center Incorporated (Goshen Medical Center-Sanford)
- Goshen Medical Center Incorporated (GMC Pharmacy at Sanford)
- Kerstin Linnea Gothson, CRNA
- Robert Blunt Gotschalk, O.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.