Active NPI
Timothy J Jordan, MD
- Developmental - Behavioral Pediatrics Physician
- Chesterfield, MO
National Provider Identifier
1164524047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental - Behavioral Pediatrics Physician
- License
- 36290
- Practice address
- 444 Chesterfield Center
Suite 205
Chesterfield, MO 63017 - Phone
- (636) 530-1883
- Fax
- (636) 530-0039
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | 36290 | MO | Primary |
Addresses
Primary practice location
444 Chesterfield Center
Suite 205
Chesterfield, MO 63017
Mailing address
444 Chesterfield Center
Suite 205
Chesterfield, MO 63017
Phone (636) 530-1883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36290 | MO | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1164524047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 CHESTERFIELD CENTER",
"address_2": "SUITE 205",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "63017",
"telephone_number": "636-530-1883",
"fax_number": "636-530-0039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 CHESTERFIELD CENTER",
"address_2": "SUITE 205",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "63017",
"telephone_number": "636-530-1883",
"fax_number": "636-530-0039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "TIMOTHY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "MO",
"license": "36290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesterfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.