Individual provider Active NPI

Jordan Lynn Klein, D.O.

  • Pediatrics Physician
  • Blacksburg, VA
National Provider Identifier
1124432737
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0102206771 Issued in VA
Practice address
3700 S Main St
Blacksburg, VA 24060-7017
Phone
(540) 739-3623
NPI assigned
Jun 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5101023312 MI
Pediatrics Physician 208000000X 0102206771 VA Primary

Addresses

Primary practice location

3700 S Main St
Blacksburg, VA 24060-7017

Mailing address

2000 Health Park Dr FL HP2
Brentwood, TN 37027-4692
Phone (615) 373-7600

Other practice location 1

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-9253

Other practice location 2

601 John St Ste E-352
Kalamazoo, MI 49007-5341
Phone (269) 341-8986

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson HealthCare Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170621001017 MI Practitioner - Pediatric Medicine 8123396868 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101023312MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W. Sparrow Hospital Association Pediatrics CurrentSince Jul 1, 2017 Accepting new patients
Bronson Methodist Hospital CurrentSince Aug 15, 2023 Accepting new patients
Edward W. Sparrow Hospital Association Pediatrics Current Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Jul 1, 2017 Accepting new patients
Bronson Methodist Hospital Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

601 John St
#E352
Kalamazoo, MI 49007
Phone (269) 341-8986

601 John St
Ste E352
Kalamazoo, MI 49007
Phone (269) 341-6475

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

1200 E Michigan Ave
Ste 460
Lansing, MI 48912
Phone (517) 364-2097

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 5

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": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1124432737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR FL HP2",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-739-3623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-9253",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 John St Ste E-352",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-8986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "JORDAN",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101023312",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102206771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "affiliationName": "Bronson HealthCare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "61 John Street",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

Verify at the official NPI Registry.