Active NPI
Alexander Jordan Eades
- Behavior Technician
- Panama City, FL
National Provider Identifier
1174197594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 21151406
- Practice address
- 850 N Tyndall Pkwy
Panama City, FL 32404-9407 - Phone
- (850) 866-0441
- NPI assigned
- May 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 21151406 | FL | Primary |
Addresses
Primary practice location
850 N Tyndall Pkwy
Panama City, FL 32404-9407
Mailing address
110 N Marie Dr
Panama City, FL 32401-4053
Phone (850) 851-7716
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21151406 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wsi Learning Centers Inc | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Panama City Beach, FL
- NPI 1396325155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1174197594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 N MARIE DR",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324014053",
"telephone_number": "850-851-7716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 N TYNDALL PKWY",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324049407",
"telephone_number": "850-866-0441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EADES",
"first_name": "ALEXANDER",
"middle_name": "JORDAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-19",
"last_updated": "2021-05-19",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "21151406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.