LILY KATHERINE GORDON
NPI 1972205904
Family Medicine in Santa Rosa, CA

Q: What is Lily Gordon's NPI number?

The NPI number for Lily Gordon is 1972205904. It was assigned to this individual provider in the NPPES registry on March 21, 2023.

Q: What is Lily Gordon's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Lily Gordon was last updated on June 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since March 21, 2023PECOS Enrolled

3569 ROUND BARN CIR STE 200, SANTA ROSA, CA 95403(707) 583-8800 Get Directions Write a Review

NPPES record last updated: June 9, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 29, 2026, Mar 21, 2023 (2 updates tracked since 2023).

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About Lily Katherine Gordon NPPES

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

LILY KATHERINE GORDON (NPI 1972205904) is an individual family medicine provider in Santa Rosa, California, licensed in California (A197279) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1972205904

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameLILY KATHERINE GORDON

Location Address3569 ROUND BARN CIR STE 200Santa Rosa, CA 95403-5784

Mailing Address3569 Round Barn Cir Ste 200Santa Rosa, CA 95403-5784

Phone(707) 583-8800

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateMarch 21, 2023

Last NPPES UpdateJune 9, 20262 updates tracked since enumeration

NPPES CertifiedJune 9, 2026

✔ NPI 1972205904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in CA · A197279

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

3569 ROUND BARN CIR STE 200, Santa Rosa, CA 95403

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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)

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

PECOS PAC ID7810474780

PECOS Enrollment IDI20260818004215

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 Lily Gordon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Santa Rosa Community Health Centers

Same address

Federally Qualified Health Center (FQHC)

3569 ROUND BARN CIRCLE
Santa Rosa, CA 95403

Reassigned Medicare billing, California enrollment
215 clinicians in this Medicare group

NPI 1578631172 (707) 303-3600

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95403 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

$96.16 typical visit price

range $63.04 – $187.01

Typical copayment $24.04 (range $15.76 – $46.75)

Most-billed visit code 99203

Established Patient

$109.88 typical visit price

range $21.02 – $153.40

Typical copayment $27.47 (range $5.25 – $38.35)

Most-billed visit code 99214

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 20

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

DR. KENDALL MADDEN M.D.

Student in an Organized Health Care Education/Training Program