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JOHNATHAN PAUL GORDON
NPI 1760965388
Social Worker in Pryor, OK

Active since September 10, 2018PECOS Enrolled
109 N FAIRLAND ST, PRYOR, OK 74361(918) 825-1405(918) 876-3436 Get Directions Write a Review

NPPES record last updated: November 13, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 13, 2020, Sep 10, 2018 (2 updates tracked since 2018).

About Johnathan Paul Gordon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHNATHAN PAUL GORDON (NPI 1760965388) is an individual social worker in Pryor, Oklahoma, licensed in Oklahoma (6386) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1760965388
Entity TypeIndividualMale
Primary Taxonomy104100000X
Provider Legal NameJOHNATHAN PAUL GORDON
Location Address109 N FAIRLAND STPryor, OK 74361-4203
Mailing Address109 N Fairland StPryor, OK 74361-4203 · (918) 825-1405 · Fax (918) 876-3436
Phone(918) 825-1405
Fax(918) 876-3436
Sole ProprietorNo
Enumeration DateSeptember 10, 2018
Last NPPES UpdateNovember 13, 20202 updates tracked since enumeration
NPPES CertifiedNovember 13, 2020
✔ NPI 1760965388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in OK · 6386
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
109 N FAIRLAND ST, Pryor, OK 74361
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Johnathan Paul Gordon is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Johnathan Gordon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Grand Lake Mental Health Center, Inc.
Same address
Mental Health (Including Community Mental Health Center)
109 N FAIRLAND ST
Pryor, OK 74361
  • Reassigned Medicare billing, Oklahoma enrollment
  • 333 clinicians in this Medicare group
NPI 1063817021 (918) 825-1405

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KALI ROSE KERNS
Peer Specialist
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1405
JACKIE ELAINE HORTON
Case Manager/Care Coordinator
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1405
WHITNEY JOANNA PHILLIPS
Peer Specialist
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1405
BREANNA NICOLE COOK MHR, LPC-C
Counselor (Mental Health)
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1401
NICOLE BURNHAM LPN
Licensed Practical Nurse
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1405
STEPHANIE RENEE STACY
Peer Specialist
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 273-1841
CRYSTAL MICHELLE CUMMINS
Case Manager/Care Coordinator
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 825-1405
KANDICE BRIANS
Peer Specialist
109 N FAIRLAND ST
PRYOR, OK 74361
Mayes County (918) 273-1841

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Johnathan Gordon's NPI number?

The NPI number for Johnathan Gordon is 1760965388. It was assigned to this individual provider in the NPPES registry on September 10, 2018.

Where is Johnathan Gordon located?

Johnathan Gordon practices at 109 N Fairland St, Pryor, OK 74361. The listed phone number is (918) 825-1405.

What is Johnathan Gordon's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Johnathan Gordon enrolled in Medicare?

Yes. Johnathan Gordon is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Johnathan Gordon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Johnathan Gordon reassigns Medicare benefits to Grand Lake Mental Health Center, Inc. (Pryor, OK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Johnathan Gordon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Johnathan Gordon was last updated on November 13, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.