NPIMap

Organization Active NPI

Jordan Physician Associates, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Plymouth, MA
National Provider Identifier
1194263186
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
JORDAN PHYSICIAN ASSOCIATES, INC.
Practice address
275 Sandwich St
Plymouth, MA 02360-2183
Phone
(508) 830-2466
NPI assigned
Feb 9, 2017
Organization subpart
Yes
Parent organization
JORDAN PHYSICIAN ASSOCIATES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Catherine J Grey
Title
Credentialing Specialist
Phone
(508) 830-2401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

275 Sandwich St
Plymouth, MA 02360-2183

Mailing address

275 Sandwich St
Plymouth, MA 02360-2183
Phone (508) 746-2000

Other identifiers 1

IdentifierTypeStateIssuer
110072193ZMedicaidMA

Other names 1

  • BIDH-Plymouth Pathology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170705000370 MA Part B Supplier - Clinic/Group Practice 1254321086 Receives reassigned benefits from 4 practitioners
Practice locations: Plymouth, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Affilliated Medical Pra

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2 Technology Park Dr
Bourne, MA 02532
Phone (508) 743-9543

1 County Rd
Bourne, MA 02532
Phone (508) 743-9543

1000 Plain St
Marshfield, MA 02050
Phone (781) 826-3838

19A Mattakeesett St
Pembroke, MA 02359
Phone (781) 293-2968

500 Congress St
Ste 2G
Quincy, MA 02169
Phone (617) 479-4450

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 415

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 415

NPI Registry JSON

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1194263186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-746-2000",
            "fax_number": "508-830-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-830-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN PHYSICIAN ASSOCIATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JORDAN PHYSICIAN ASSOCIATES, INC.",
        "enumeration_date": "2017-02-09",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "GREY",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "508-830-2401"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110072193Z",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BIDH-Plymouth Pathology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BIDH-Plymouth Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.