Jordan Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA101388 Issued in MA

Practice address

100 New State Hwy
Raynham, MA 02767-5423

Phone

(781) 666-2711

Fax

(781) 666-2712

NPI assigned

Jul 17, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA, MA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Neuro Behavioral Care LLCGroup PAC ID 2860721362, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Spectrum Neuro Behavioral Care LLC

  dba SNBCare

  • Community/Behavioral Health Agency
  • North Smithfield, RI
  • NPI 1356906572

  MA

  Medicare reassignment Care Compare group
• Cascade Community Healthcare

  dba Cascade Mental Health Care

  • Community/Behavioral Health Agency
  • Centralia, WA
  • NPI 1619068624
  Medicare reassignment
• Cognitive Neurology Consultants PA

  • Behavioral Neurology & Neuropsychiatry Physician
  • New York, NY
  • NPI 1679018089
  NPD (past)

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1235651720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NEW STATE HWY",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675423",
            "telephone_number": "781-666-2711",
            "fax_number": "781-666-2712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NEW STATE HWY",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675423",
            "telephone_number": "781-666-2711",
            "fax_number": "781-666-2712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3469 N Dixie Hwy",
            "address_purpose": "LOCATION",
            "city": "Oakland Park",
            "state": "FL",
            "postal_code": "333342872",
            "country_code": "US",
            "telephone_number": "305-912-4323",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2428 W Reynolds Ave",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "WA",
            "postal_code": "98531",
            "country_code": "US",
            "telephone_number": "360-330-9044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-17",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "FL",
            "license": "9110440",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60855409",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA101388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2101119",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikkia Watson, LICSW
• Patrick Michael Weintraub, LMHC
• Kelli Anne Welby
• Lauren Beth Wenzl, PA-C
• Sandra Lynn Willis, RPT
• Krystal Victoria Winfield
• Candace Wolkowicz, D.M.D.
• Scott I Worobey, M.S.P.T.
• Deborah Worthington, NP
• Jennifer Ann Yutz, COTA/L

• Physician Assistant in Raynham, MA
• Providers in Raynham, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; 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.