Active NPI
Jordan Paige Spivak, MS, RD, LDN
- Registered Dietitian
- Arlington, VA
National Provider Identifier
1073084588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI200001355
- Practice address
- 2100 S Quebec St
Arlington, VA 22204-5122 - Phone
- (630) 615-9144
- NPI assigned
- Dec 10, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.007548 | IL | |
| Registered Dietitian | 133V00000X | DI200001355 | DC | Primary |
Addresses
Primary practice location
2100 S Quebec St
Arlington, VA 22204-5122
Mailing address
2100 S Quebec St
Arlington, VA 22204-5122
Phone (630) 615-9144
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI200001355 | DC | MD | Registered Dietitian |
| 164.007548 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1073084588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 S QUEBEC ST",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222045122",
"telephone_number": "630-615-9144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 S QUEBEC ST",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222045122",
"telephone_number": "630-615-9144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVAK",
"first_name": "JORDAN",
"middle_name": "PAIGE",
"name_prefix": "Miss",
"credential": "MS, RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-10",
"last_updated": "2024-09-03",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.007548",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "DC",
"license": "DI200001355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.