NPIMap

Individual provider Active NPI

Sandra Shepherd Gordon, PA

  • Medical Physician Assistant
  • Hartford, CT
National Provider Identifier
1982031159
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5070 Issued in CT
Practice address
85 Retreat Ave
Hartford, CT 06106-2555
Phone
(860) 972-4183
NPI assigned
Oct 3, 2013
Last updated
Feb 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5070 CT Primary
Medical Physician Assistant 363AM0700X 017044 NY

Addresses

Primary practice location

85 Retreat Ave
Hartford, CT 06106-2555

Mailing address

19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140
Phone (914) 909-9018

Other practice location 1

19 Bradhurst Ave Ste 2100N
Hawthorne, NY 10532-2140
Phone (914) 493-8375

Other practice location 2

21 Audubon Ave.
Columbia Department of Surgery
New York, NY 10032
Phone (212) 305-8467

Other practice location 3

5 Founders St
Willimantic, CT 06226-2048
Phone (860) 533-5330

Other names 1

  • Ms. Sandra Lynn Shepherd Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, HI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210209000086 CT Practitioner - Physician Assistant 7911312731 Reassigns benefits to 3 organizations
I20230105002947 HI Practitioner - Physician Assistant 7911312731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford HospitalGroup PAC ID 2567366016, 1,040 clinicians

Practice addresses (Care Compare)

80 Fisher Dr
Avon, CT 06001-3798
Phone (860) 696-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.8 of 100Reported as group
Quality
90
Promoting interoperability
100
Improvement activities
40
Cost
78.43

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as group
Quality
75.35
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Pathology Associates, P.C. Current Accepting new patients
Hartford Hospital CurrentSince Apr 2, 2021 Accepting new patients
Oncology Associates, PC CurrentSince Feb 12, 2023 Accepting new patients
William W Backus Hospital CurrentSince Sep 15, 2023 Accepting new patients
Hartford Hospital CurrentSince Apr 2, 2021 Accepting new patients
Windham Community Memorial Hospital Past Accepting new patients

Locations

85 Retreat Ave
Hartford, CT 06106
Phone (860) 249-6291

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

Interoperability endpoints

  • Direct secure messaging: sandra.gordon@xdr.hhchealthdirect.org

Organizations & group practices 9

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 2

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": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1982031159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3100N",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-909-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 RETREAT AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062555",
            "telephone_number": "860-972-4183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Bradhurst Ave Ste 2100N",
            "address_purpose": "LOCATION",
            "city": "Hawthorne",
            "state": "NY",
            "postal_code": "105322140",
            "country_code": "US",
            "telephone_number": "914-493-8375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21 Audubon Ave.",
            "address_2": "Columbia Department of Surgery",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10032",
            "country_code": "US",
            "telephone_number": "212-305-8467",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Founders St",
            "address_purpose": "LOCATION",
            "city": "Willimantic",
            "state": "CT",
            "postal_code": "062262048",
            "country_code": "US",
            "telephone_number": "860-533-5330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SANDRA",
        "middle_name": "SHEPHERD",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "5070",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017044",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "SHEPHERD",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.