Active NPI
Gordon Faulkner, MD
- Pediatrics Physician
- Mount Horeb, WI
National Provider Identifier
1942307962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 22351
- Practice address
- 2002 E Blue Mounds Rd
Mount Horeb, WI 53572-2634 - Phone
- (608) 274-9717
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22351 | WI | Primary |
Addresses
Primary practice location
2002 E Blue Mounds Rd
Mount Horeb, WI 53572-2634
Mailing address
2002 E Blue Mounds Rd
Mount Horeb, WI 53572-2634
Phone (608) 274-9717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30501900 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22351 | WI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490227200000",
"number": "1942307962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 E BLUE MOUNDS RD",
"city": "MOUNT HOREB",
"state": "WI",
"postal_code": "535722634",
"telephone_number": "608-274-9717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 E BLUE MOUNDS RD",
"city": "MOUNT HOREB",
"state": "WI",
"postal_code": "535722634",
"telephone_number": "608-274-9717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "GORDON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2017-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "22351",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30501900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Horeb, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.