Active NPI
Jordyn Carroll
- Developmental - Behavioral Pediatrics Physician
- Washington, DC
National Provider Identifier
1013477074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental - Behavioral Pediatrics Physician
- License
- 000000
- Practice address
- 102 Michigan Ave NE
Washington, DC 20017-1027 - Phone
- (951) 818-7734
- NPI assigned
- Mar 24, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | 000000 | DC | Primary |
Addresses
Primary practice location
102 Michigan Ave NE
Washington, DC 20017-1027
Mailing address
102 Michigan Ave NE
Washington, DC 20017-1027
Phone (951) 818-7734
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000 | DC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553385600000",
"number": "1013477074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 MICHIGAN AVE NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200171027",
"telephone_number": "951-818-7734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 MICHIGAN AVE NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200171027",
"telephone_number": "951-818-7734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "JORDYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-24",
"last_updated": "2019-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "DC",
"license": "000000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.