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DR. BROCK VAN GORDON D.M.D.
NPI 1962554584
Dentist - General Practice in Tualatin, OR

Active since January 16, 2007Opted out of Medicare · through Dec 1, 2027
6485 SW BORLAND RD STE G, TUALATIN, OR 97062(503) 878-4163(833) 438-7620 Get Directions Write a Review

NPPES record last updated: July 14, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Brock Van Gordon D.m.d. NPPES

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

DR. BROCK VAN GORDON D.M.D. (NPI 1962554584) is an individual general practice provider in Tualatin, Oregon, licensed in Oregon (D7947) and active in the NPI registry since January 2007. He has opted out of Medicare through December 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1962554584
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. BROCK VAN GORDONCredential: D.M.D.
Location Address6485 SW BORLAND RD STE GTualatin, OR 97062-9762
Mailing Address6485 Sw Borland Rd Ste GTualatin, OR 97062-9762 · (503) 730-4924 · Fax (833) 438-7620
Phone(503) 878-4163
Fax(833) 438-7620
Sole ProprietorYes
Enumeration DateJanuary 16, 2007
Last NPPES UpdateJuly 14, 2025
NPPES CertifiedJuly 14, 2025
✔ NPI 1962554584 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in OR · D7947
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Also ListedDentistTaxonomy 122300000X · License D7947 (OR)
6485 SW BORLAND RD STE G, Tualatin, OR 97062
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Humana, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Brock Van Gordon D.m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 1, 2015 through December 1, 2027.

Opt-Out Effective DateDecember 1, 2015
Opt-Out In Effect ThroughDecember 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97062 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.51 typical visit price
range $58.99 – $176.88
Typical copayment $22.62 (range $14.74 – $44.22)
Most-billed visit code 99203
Established Patient
$73.28 typical visit price
range $19.32 – $144.79
Typical copayment $18.32 (range $4.83 – $36.19)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

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

BROCK A VAN GORDON DMD, PC
Clinic/Center (Sleep Disorder Diagnostic)
6485 SW BORLAND RD STE G
TUALATIN, OR 97062
Washington County (503) 878-4163
PACIFIC MEDICINE CONSULTING LLC
Clinic/Center (Medical Specialty)
6485 SW BORLAND RD STE G
TUALATIN, OR 97062
Washington County (267) 616-3681
HEALING PROVINCE MASSAGE LLC
Massage Therapist
6485 SW BORLAND RD STE G
TUALATIN, OR 97062
Washington County (971) 396-7475

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 Brock Van Gordon's NPI number?

The NPI number for Brock Van Gordon is 1962554584. It was assigned to this individual provider in the NPPES registry on January 16, 2007.

Where is Brock Van Gordon located?

Brock Van Gordon practices at 6485 SW Borland Rd Ste G, Tualatin, OR 97062. The listed phone number is (503) 878-4163.

What is Brock Van Gordon's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Brock Van Gordon enrolled in Medicare?

No. Brock Van Gordon has opted out of Medicare through December 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Brock Van Gordon accept?

Health plans from BridgeSpan Health Company, Humana and Regence BlueCross BlueShield of Oregon list Brock Van Gordon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brock Van Gordon was last updated on July 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.