Active NPI
Matt Jordan
- Athletic Trainer
- Minneapolis, MN
National Provider Identifier
1053717355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2457
- Practice address
- 3112 Humboldt Ave S
Apartment 4
Minneapolis, MN 55408-2683 - Phone
- (612) 508-4967
- NPI assigned
- Nov 13, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2457 | MN | Primary |
Addresses
Primary practice location
3112 Humboldt Ave S
Apartment 4
Minneapolis, MN 55408-2683
Mailing address
3112 Humboldt Ave S
Apartment 4
Minneapolis, MN 55408-2683
Phone (612) 508-4967
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 |
|---|---|---|---|
| 2457 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415836800000",
"number": "1053717355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3112 HUMBOLDT AVE S",
"address_2": "APARTMENT 4",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082683",
"telephone_number": "612-508-4967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3112 HUMBOLDT AVE S",
"address_2": "APARTMENT 4",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082683",
"telephone_number": "612-508-4967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "MATT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-13",
"last_updated": "2014-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.