Carly Gordon, MA is a medicare enrolled "Speech-language Pathologist" provider in Piedmont, California. Her current practice location is
Telemedicine Service, 15 Olive Ave, Piedmont, California. You can reach out to her office (for appointments etc.) via phone at
(209) 210-8262.
Carly Gordon is licensed to practice in Hawaii (license number SP-1478) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1457734626.
Healthcare Provider's Profile
| Full Name | Carly Gordon |
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| Gender | Female |
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| Speciality | Speech-language Pathologist |
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| Location | Telemedicine Service, Piedmont, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1457734626
- Provider Enumeration Date: 07/06/2015
- Last Update Date: 11/17/2020
Medicare PECOS Information:
- PECOS PAC ID: 6507143948
- Enrollment ID: I20170511002464
Medical Identifiers
Medical identifiers for Carly Gordon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457734626 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 235Z00000X | Speech-language Pathologist | SP-1478 (Hawaii) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carly Gordon allows following entities to bill medicare on her behalf.
| Provider Name | Terrio Therapy-fitness Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1841267689
PECOS PAC ID: 8628059805
Enrollment ID: O20040525000579 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carly Gordon is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Carly Gordon, MA
15 Olive Ave # 11,
Piedmont, CA 94611-4427
Ph: (209) 210-8262 | Carly Gordon, MA
Telemedicine Service, 15 Olive Ave,
Piedmont, CA 94611-4427
Ph: (209) 210-8262 |
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