Carmelina Gordon, M.D.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

4301063145 Issued in MI

Practice address

850 W North St Ste 100
Jackson, MI 49202-3196

Phone

(877) 852-8463

Fax

(517) 841-3034

NPI assigned

Oct 11, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

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

Ophthalmology

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mid Michigan Eye Care Center PCGroup PAC ID 4486566098, 31 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cgordon462655@direct.hfhs.org

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.

• Mid Michigan Eye Care Center, PC

  dba Specialty Eye Institute

  • Ophthalmology Physician
  • Jackson, MI
  • NPI 1649275041
  Medicare reassignment Care Compare group NPD
• Surgical Services of Michigan, LLC

  dba Blake Woods Medical Park

  • Ambulatory Surgical Clinic/Center
  • Jackson, MI
  • NPI 1588631832
  Medicare reassignment
• DRS. Ravin, Birndorf & Ravin, Inc.

  dba Specialty Eye Institute

  • Ophthalmology Physician
  • Toledo, OH
  • NPI 1316043110
  NPD
• Ohio Vision of Toledo Inc

  dba Optivue

  • Specialist
  • Oregon, OH
  • NPI 1528096203
  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1952399297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W NORTH ST STE 104",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023196",
            "telephone_number": "877-852-8463",
            "fax_number": "517-817-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W NORTH ST STE 100",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023196",
            "telephone_number": "877-852-8463",
            "fax_number": "517-841-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CARMELINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301063145",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MI",
            "license": "4301063145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "180H149970",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180044966",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4380786",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4496389",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "180C846310",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Elizabeth Goodrich
• Max Gorcyca
• Christi Ann Gorczyca, DVM
• Patrick Joseph Gorczyca, DVM
• Elizabeth Anne Gordon Spratt, M.D.
• Kirstyn Jane Gordon, MSW, LLMSW
• Grace in Healing
• Jennifer Jean Grace, LBSW
• Brooklyn Granowicz
• Eric Michael Granowicz, M.D.

• Retina Specialist (Ophthalmology) Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Retina Specialist (Ophthalmology) Physician in Michigan

• 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.
• 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.