Nicole Gordon, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Phoenix, Arizona. Her current practice location is
10000 N 31st Ave Ste D407, Phoenix, Arizona. You can reach out to her office (for appointments etc.) via phone at
(602) 718-1266.
Nicole Gordon is licensed to practice in Arizona (license number LCSW-17933) 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 1871144535.
Healthcare Provider's Profile
| Full Name | Nicole Gordon |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 10000 N 31st Ave Ste D407, Phoenix, Arizona |
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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: 1871144535
- Provider Enumeration Date: 09/24/2019
- Last Update Date: 07/20/2023
Medicare PECOS Information:
- PECOS PAC ID: 1052726098
- Enrollment ID: I20210224002342
Medical Identifiers
Medical identifiers for Nicole Gordon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1871144535 | NPI | - | NPPES |
| 087415 | Medicaid | AZ | |
| 000710 | Medicaid | AZ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | LCSW-17933 (Arizona) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW-17933 (Arizona) | 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. Nicole Gordon allows following entities to bill medicare on her behalf.
| Entity Name | Phoenix Children's Hospital |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1922112044
PECOS PAC ID: 0446278584
Enrollment ID: O20051107000704 |
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| Entity Name | Best Self, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1609475144
PECOS PAC ID: 0143635185
Enrollment ID: O20210224002299 |
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| Entity Name | Sondermind Provider Network Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1760854442
PECOS PAC ID: 9537572490
Enrollment ID: O20210318002844 |
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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. Nicole 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 |
|---|
Nicole Gordon, LCSW
6537 N 55th Ave # 473,
Glendale, AZ 85301-3959
Ph: (602) 718-1266 | Nicole Gordon, LCSW
10000 N 31st Ave Ste D407,
Phoenix, AZ 85051-1352
Ph: (602) 718-1266 |
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