Joerdan Ricketts, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

107059 Issued in FL

Practice address

3100 SW 62ND Ave
Miami, FL 33155-3009

Phone

(305) 666-6511

NPI assigned

Feb 8, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Joerdan Williams Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1073845558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278485",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330278485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-666-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "JOERDAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-08",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "107059",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "067740",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124270A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002671100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOERDAN",
            "last_name": "WILLIAMS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Richter
• Franz Edgardo Richter, MD
• Lindsey Paige Richter, MS, CCC-SLP
• Rick & Dauvy Alf, Inc
• Henrietta Ricketts, HS
• Jutesha Ricketts
• Eloy Rico Amador
• Rico Counseling Corp
• Rene Rico Tresgallo, M.D.
• Ada Beatriz Rico

• Pediatrics Physician in Miami, FL
• Providers in Miami, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.