MR. JONATHAN GORDON (PT) – Physical Therapist, NPI 1104004886

MR. JONATHAN GORDON (PT) is a healthcare provider. based in Saint louis, Missouri. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. 105413 (MO). The NPI Number for MR. JONATHAN GORDON (PT) is 1104004886

Main info

Male
39 Years Of Experience
Accepts Medicare Assignment
Name
MR. JONATHAN GORDON (PT)
NPI
1104004886
Phone
(314) 644-1978
Address
6744 CLAYTON RD
Enumeration Date
5 February 2008
Last Update Date
5 February 2008

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3149168751
Graduation Year
1987 (39 years ago)
PAC ID
2567443070
Group Practice PAC ID
8224923800
Professional Enrollment ID
I20240329000998
Address ID
MO631052465CL950XXPLXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness75
Years active:18State licenses:1Digital endpointsOther names

1,533 PHYSICAL THERAPIST IN PRIVATE PRACTICE in MO

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Provider Addresses for MR. JONATHAN GORDON (PT)

  • Big Bend Professional Building, 6744, Clayton Road, Richmond Heights, Saint Louis County, Missouri, 63117, United States

    SUITE 220

    SAINT LOUIS, MO 631171637

    Phone: (314) 644-1978

    Fax: (314) 647-1350

    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: 2024-03-29

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
I20240329000998IPhysical Therapist In Private PracticeMOTBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63117)

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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: 8224923800View full group profile
NameSpecialtyState
Occupational Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO
Occupational Therapist In Private PracticeMO
Physical Therapist In Private PracticeIL
Physical Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO
Occupational Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO

Reviews

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Frequently asked questions

Is MR. JONATHAN GORDON (PT) listed with a National Provider Identifier?
Yes — MR. JONATHAN GORDON (PT) has NPI 1104004886 on file in the registry.
Is there an active status for MR. JONATHAN GORDON (PT)?
For scheduling context, MR. JONATHAN GORDON (PT) is shown as active in the registry.
What clinical focus is listed for MR. JONATHAN GORDON (PT)?
At a glance, MR. JONATHAN GORDON (PT) is tied to Physical Therapist. Clinical services aligned with this taxonomy classification.
What locale is associated with MR. JONATHAN GORDON (PT)?
Directory geography for MR. JONATHAN GORDON (PT) centers on Saint Louis, Missouri.
Does MR. JONATHAN GORDON (PT) accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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