Kenneth Wayne Jordan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

33260 Issued in NC

Practice address

2100 Erwin Rd
Durham, NC 27705-3941

Phone

(919) 684-8111

NPI assigned

Jun 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjordan95106@capefearvalley.direct-ci.com

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.

• Bladen Healthcare LLC

  • Critical Access Hospital
  • Elizabethtown, NC
  • NPI 1558537282
  Medicare reassignment NPD
• Bladen Healthcare LLC

  • Rural Health Clinic/Center
  • Whiteville, NC
  • NPI 1821764390
  NPD
• Bladen Healthcare, LLC

  • Rural Health Clinic/Center
  • Elizabethtown, NC
  • NPI 1255507737
  NPD

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251763200000",
    "number": "1184628505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053941",
            "telephone_number": "919-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053941",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2009-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "33260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BJ1675531",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8947445",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Nicole Jordan
• Brett Winters Jordan, FNP-C
• Daniel Jordan, LCSWA
• Darrell Keith Jordan Jr., PT
• Emily Hrdina Jordan, MA CCC-SLP
• Lashaunta Bullock Jordan
• Megan Jordan, MD
• Molly Ellen Rush Jordan, PHYSICIAN ASSISTANT
• River James Jordan, MD
• Walter Wayne Jordan, DDS PA

• Pediatrics Physician in Durham, NC
• Providers in Durham, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.