Individual provider Active NPI

Jordan Davis Santaloci, PA-C

  • Physician Assistant
  • Asheville, NC
National Provider Identifier
1093287583
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08749 Issued in NC
Practice address
900A Centrepark Dr
Asheville, NC 28805-1274
Phone
(828) 767-1643
Fax
(828) 676-1075
NPI assigned
Dec 20, 2018
Last updated
Jul 29, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-08749 NC Primary

Addresses

Primary practice location

900A Centrepark Dr
Asheville, NC 28805-1274

Mailing address

PO Box 25804
Winston Salem, NC 27114-5804
Phone (364) 448-9100

Other practice location 1

1521 Owen Park Ln
Fayetteville, NC 28304-3454
Phone (910) 223-7420

Other practice location 2

3821 Forrestgate Dr
Winston Salem, NC 27103-2930
Phone (336) 448-9100

Other identifiers 2

IdentifierTypeStateIssuer
NN5736AOtherNCMEDICARE PTAN
1093287583MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ernesto J F Graham MD PA CurrentSince Feb 4, 2019 Accepting new patients
A Brighter Future Medical PastSince Sep 15, 2024 Accepting new patients
Carolinas Fertility Institute, P.a. PastSince Jul 31, 2023 Accepting new patients

Locations

1521 Owen Park Ln
Fayetteville, NC 28304
Phone (910) 223-7420

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1093287583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25804",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271145804",
            "telephone_number": "364-448-9100",
            "fax_number": "336-448-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900A CENTREPARK DR",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288051274",
            "telephone_number": "828-767-1643",
            "fax_number": "828-676-1075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1521 Owen Park Ln",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043454",
            "country_code": "US",
            "telephone_number": "910-223-7420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3821 Forrestgate Dr",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271032930",
            "country_code": "US",
            "telephone_number": "336-448-9100",
            "fax_number": "336-448-5282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTALOCI",
        "first_name": "JORDAN",
        "middle_name": "DAVIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "NN5736A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093287583",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheville, NC

Sources for this page

Verify at the official NPI Registry.