NPIMap

Organization Active NPI

Jordan's Place Pediatrics, PA

  • Rural Health Clinic/Center
  • Sulphur Springs, TX
National Provider Identifier
1063277903
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JORDAN'S PLACE PEDIATRICS, PA
Practice address
1317 N Hillcrest Dr
Sulphur Springs, TX 75482-2091
Phone
(903) 438-1110
Fax
(903) 438-1107
NPI assigned
Feb 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sherri Stone Barclay, MDNPI 1154381259
Title
Medical Director
Phone
(903) 438-1110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1317 N Hillcrest Dr
Sulphur Springs, TX 75482-2091

Mailing address

1317 N Hillcrest Dr
Sulphur Springs, TX 75482-2091
Phone (903) 438-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240516003464 TX Part A Provider - Rural Health Clinic 3971944208 Practice locations: Sulphur Springs, TX

Rural health clinic certification: CCN 678928

Legal name
JORDANS PLACE PEDIATRICS PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 26, 2024
Last certification
Aug 26, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 18, 2001 in TX
Enrollment address
1317 N Hillcrest Dr
Sulphur Springs, TX 75482-2091

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jordans Place Pediatrics PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11247/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sherri Barclay Individual 5% Or Greater Direct Ownership InterestOwner Mar 1, 2024 100%
Corporate OfficerOwner Mar 1, 2024
Corporate DirectorOwner Mar 1, 2024
W-2 Managing EmployeeOwner Mar 1, 2024

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1063277903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 N HILLCREST DR",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822091",
            "telephone_number": "903-438-1110",
            "fax_number": "903-438-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 N HILLCREST DR",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822091",
            "telephone_number": "903-438-1110",
            "fax_number": "903-438-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN'S PLACE PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "BARCLAY",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_middle_name": "STONE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "903-438-1110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sulphur Springs, TX

Sources for this page

Verify at the official NPI Registry.