DR. KEITH L III GORDON (M.D.) – Psychiatry Physician, NPI 1053473629

DR. KEITH L III GORDON (M.D.) is a healthcare provider. based in Colton, California. specializing in PSYCHIATRY. They hold the professional credentials M.D.. They hold a License No. A42732 (CA). The NPI Number for DR. KEITH L III GORDON (M.D.) is 1053473629

Main info

Male
Sole Proprietor
43 Years Of Experience
Accepts Medicare Assignment
Name
DR. KEITH L III GORDON (M.D.)
NPI
1053473629
Phone
(909) 580-3830
Address
400 N PEPPER AVE
Enumeration Date
13 December 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9095801000
Graduation Year
1983 (43 years ago)
PAC ID
6709116205
Group Practice PAC ID
0244522159
Professional Enrollment ID
I20190926000804
Address ID
CA923241801CO400XXAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

4,134 PSYCHIATRY in CA

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Provider Addresses for DR. KEITH L III GORDON (M.D.)

  • 400, Pepper Avenue, West Colton, Colton, San Bernardino County, California, 92324, United States

    COLTON, CA 923241801

    Phone: (909) 580-3830

    Fax: (909) 580-3814

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-09-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20190926000804IPsychiatryCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99223Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes4141$0
99285Emergency department visit with high level of medical decision making1616$0
View full utilization report →

Insurance plans in this area (ZIP 92324)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0244522159View full group profile
NameSpecialtyState
-CA
P S Y C H I A T R YCA
P S Y C H I A T R YCA
P S Y C H I A T R YCA
P S Y C H I A T R YCA
Nurse PractitionerCA
-CA
P S Y C H I A T R YCA
-CA
P S Y C H I A T R YCA

Reviews

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Frequently asked questions

Where can patients find DR. KEITH L III GORDON (M.D.)'s NPI?
You can confirm DR. KEITH L III GORDON (M.D.) with NPI 1053473629; it appears in the national provider directory.
Is DR. KEITH L III GORDON (M.D.) active in the national directory?
DR. KEITH L III GORDON (M.D.)'s public NPI profile is in an active state.
What does DR. KEITH L III GORDON (M.D.) treat or focus on?
Patients typically see DR. KEITH L III GORDON (M.D.) under the specialty Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for DR. KEITH L III GORDON (M.D.)?
The page summarizes Colton, California for DR. KEITH L III GORDON (M.D.); expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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