Individual provider Active NPI

Jordan H Eisenstock, M.D.

  • Neurology Physician
  • Worcester, MA
National Provider Identifier
1164573283
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
231108 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 334-2527
Fax
(774) 442-3687
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 231108 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other identifiers 1

IdentifierTypeStateIssuer
2149877MedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jeisenstock22600@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20080924000014 MA Practitioner - NeurologyPractitioner - Psychiatry 4486721073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Psychiatry
Education
University of Massachusetts Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Neuroscience Services LLCGroup PAC ID 1658688031, 23 clinicians
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

33 Lyman St
Suite 400
Westborough, MA 01581-1434
Phone (508) 898-0055

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Milford Regional Medical Center Hospital, Milford, MA, CCN 220090
  • Marlborough Hospital Hospital, Marlborough, MA, CCN 220049
  • St Vincent Hospital Hospital, Worcester, MA, CCN 220176

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
231108MAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Aug 1, 2008 Accepting new patients
Umass Memorial Medical Group Inc Current Accepting new patients
Community Neuroscience Services, LLC Neurology CurrentSince Sep 1, 2015 Accepting new patients
Tak Medical Group, P.C. Past Accepting new patients

Locations

14 Monument Sq
Ste 401
Leominster, MA 01453
Phone (978) 728-4455

33 Lyman St
Ste 400
Westborough, MA 01581
Phone (508) 898-0055

119 Belmont St
Worcester, MA 01605
Phone (508) 334-6345

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: jeisenstock22600@umassmemorial.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/IJCCDA

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1164573283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-2527",
            "fax_number": "774-442-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENSTOCK",
        "first_name": "JORDAN",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "231108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2149877",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeisenstock22600@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "119 Belmont St",
            "address_2": "Department of Neurology",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016052903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "119 Belmont St",
            "address_2": "Department of Neurology",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016052903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.