Jordan Marcou, PA-C – Physician Assistant

Key facts

NPI: 1154834786
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 4008 (CT)
Practice address: 5520 Park Ave
Trumbull, CT 06611
Phone: (203) 373-7330
NPI assigned: Nov 6, 2017
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Cyril Waynik MD PC Psychiatry Physician · Fairfield, CT · NPI 1467675850

Medicare reassignment Care Compare group CT

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2017
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Cyril Waynik MD PC (9 clinicians)

Practice addresses (Care Compare)

52 Beach Rd
Suite 104
Fairfield, CT 06824-6017
Phone (203) 254-2000

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CT
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20180202001722	CT	Practitioner - Physician Assistant	7719247113	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
4008	CT	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medical Physician Assistant	363AM0700X
Physician Assistant	363A00000X	4008	CT	Yes

Addresses

Primary practice location

5520 Park Ave
Trumbull, CT 06611

Mailing address

52 Beach Rd Ste 104
Fairfield, CT 06824-6692
Phone (203) 254-3570

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 1, 2020.

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1154834786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 BEACH RD STE 104",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246692",
            "telephone_number": "203-254-3570",
            "fax_number": "203-255-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5520 PARK AVE",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "06611",
            "telephone_number": "203-373-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCOU",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-06",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

All providers in Trumbull, CT · Physician Assistant in Connecticut

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.