Individual provider Active NPI

Jordan Estuardo Palma, DPT

  • Physical Therapist
  • Venice, FL
National Provider Identifier
1114647112
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT42427 Issued in FL
Practice address
3030 Executive Dr
Venice, FL 34292-2613
Phone
(941) 485-1505
Fax
(941) 485-7495
NPI assigned
Aug 30, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 18617 CO
Physical Therapist 225100000X PT42427 FL Primary

Addresses

Primary practice location

3030 Executive Dr
Venice, FL 34292-2613

Mailing address

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

Other practice location 1

15000 W 6th Ave Unit 106-B
Golden, CO 80401-6586
Phone (720) 541-6817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220919002348 CO Practitioner - Physical Therapist in Private Practice 9638554264 Reassigns benefits to 1 organization
I20241031002561 FL Practitioner - Physical Therapist in Private Practice 9638554264 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Orthopaedic Surgery and Sports Medicine, P.a.Group PAC ID 0648296285, 14 clinicians

Practice addresses (Care Compare)

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

Merit-based Incentive Payment System (MIPS)

Final score
96.68 of 100Reported as group
Quality
96.09
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18617COMDPhysical Therapist
PT42427FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Panorama Orthopedics and Spine Center PC Current Accepting new patients
Panorama Orthopedics & Spine Center, PC CurrentSince Sep 7, 2022 Accepting new patients
Suncoast Orthopaedic Surgery & Sports Medicine, P.a. CurrentSince Oct 24, 2024 Accepting new patients
Panorama Orthopedics & Spine Center, PC CurrentSince Sep 7, 2022 Accepting new patients

Locations

15530 W 64th Ave
Unit E
Arvada, CO 80007
Phone (303) 424-4589

660 Golden Ridge Rd
Ste 250
Golden, CO 80401
Phone (303) 274-7321

15000 W 6th Ave
Unit 106B
Golden, CO 80401
Phone (720) 541-6817

3030 Executive Dr
Venice, FL 34292
Phone (941) 485-1505

836 Sunset Lake Blvd
Ste 205A
Venice, FL 34292
Phone (941) 485-1505

Organizations & group practices 4

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": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1114647112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15000 W 6th Ave Unit 106-B",
            "address_purpose": "LOCATION",
            "city": "Golden",
            "state": "CO",
            "postal_code": "804016586",
            "country_code": "US",
            "telephone_number": "720-541-6817",
            "fax_number": "720-541-6818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMA",
        "first_name": "JORDAN",
        "middle_name": "ESTUARDO",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-30",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "18617",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT42427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.