Jacqueline Jordan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

23.004134 Issued in CT

Practice address

809 Main St
East Hartford, CT 06108-3142

Phone

(860) 528-1359

NPI assigned

Jun 28, 2018

Last updated

Jun 28, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

First Choice Health Centers IncGroup PAC ID 2769417609, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• First Choice Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
  • NPI 1215923131

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• First Choice Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
  • NPI 1215518733
  NPD

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1215422514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 SHERMAN LN",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065141326",
            "telephone_number": "201-312-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 MAIN ST",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083142",
            "telephone_number": "860-528-1359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "94 Connecticut Blvd",
            "address_purpose": "LOCATION",
            "city": "East Hartford",
            "state": "CT",
            "postal_code": "061083013",
            "country_code": "US",
            "telephone_number": "860-528-1359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "23.004134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmin Johnson, MSN-ED, APRN, PMHNP
• Tania Shade Johnson, MS,BCBA
• Katherine Elizabeth Jones, RDH
• Octavya Jones
• Stacy Eileen Jones, LCSW
• Won Hae Ju, M.D.
• Nancy Kalagher, APRN
• Susan Kambe, APRN
• Andrew Kane, CRNA
• Chiradip Kar, DDS

• Medical Physician Assistant in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.