Organization Active NPI

Platinum Wound Care Specialist

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1174208763
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PLATINUM WOUND CARE SPECIALIST
Practice address
3830 E Flamingo Rd Ste 201
Las Vegas, NV 89121-6234
Phone
(702) 659-5604
Fax
(702) 660-6186
NPI assigned
Jun 20, 2023
Last updated
Aug 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Authorized official

Name
Craig JorgensonNPI 1588646830
Title
Owner
Phone
(702) 659-5604

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3830 E Flamingo Rd Ste 201
Las Vegas, NV 89121-6234

Mailing address

1000 N Green Valley Pkwy Ste 440-127
Henderson, NV 89074-6170
Phone (702) 659-5604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240321001693 NV Part B Supplier - Clinic/Group Practice 1658718093 Receives reassigned benefits from 4 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754438400000",
    "number": "1174208763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N GREEN VALLEY PKWY STE 440-127",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890746170",
            "telephone_number": "702-659-5604",
            "fax_number": "702-660-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 E FLAMINGO RD STE 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891216234",
            "telephone_number": "702-659-5604",
            "fax_number": "702-660-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM WOUND CARE SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "JORGENSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-659-5604"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.