Jordan Wiseman, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA12258 Issued in TX

Practice address

1 Sugar Creek Center Blvd Ste 618
Sugar Land, TX 77478-3540

Phone

(832) 655-4141

Fax

(713) 457-5188

NPI assigned

Sep 28, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jordan.wiseman.1@8363.direct.athenahealth.com

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.

• Dell Children'S Medical Group

  • Pediatrics Physician
  • Austin, TX
  • NPI 1326072943
  Medicare reassignment NPD
• Universal Surgical Assistants Inc.

  • Surgical Technologist
  • Sugar Land, TX
  • NPI 1215220116
  Medicare reassignment
• Dell Children'S Medical Group

  • Pediatrics Physician
  • Round Rock, TX
  • NPI 1790103869
  NPD
• Sienna Practitioners PLLC

  • Surgical Physician Assistant
  • Missouri City, TX
  • NPI 1750741047
  NPD (past)

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1144705898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SUGAR CREEK CENTER BLVD STE 618",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774783540",
            "telephone_number": "832-655-4141",
            "fax_number": "713-457-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SUGAR CREEK CENTER BLVD STE 618",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774783540",
            "telephone_number": "832-655-4141",
            "fax_number": "713-457-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "JORDAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA12258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - UNIVERSAL SURGICAL PARTNERS",
            "identifier": "8KE886",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - XCITE SURGICAL",
            "identifier": "8KE884",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - BLUE STAR SURGICAL ASSISTANTS LLC",
            "identifier": "8LI002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - UNIVERSAL SURGICAL ASSISTANTS",
            "identifier": "8KE885",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "PA12258",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Wayne Wimberly
• Jamie Lynn Winderweedle Wall, AU.D., CCC/A
• Mumeenat Winjobi, MD
• Winnie-Stowell Hospital District
• Maria Elizabeth Winzerling, PT
• Wisemoney Corporation
• Wishnow-Sugar Vision
• Wishnow-Sugar Vision Group PC
• Daniel Alan Wishnow, O.D.
• Harwin Wo

• Surgical Physician Assistant in Sugar Land, TX
• Providers in Sugar Land, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.