Jordan Connelly

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25228 Issued in SC

Practice address

631 Johnnie Dodds Blvd
Mount Pleasant, SC 29464-3030

Phone

(843) 881-0815

NPI assigned

Nov 12, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, FL, VT, NY, MA5 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 5

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661

  SC, VT

  Medicare reassignment
• Openloop Healthcare Partners California PC

  • Plastic and Reconstructive Surgery Physician
  • Los Angeles, CA
  • NPI 1598418063
  NPD
• Openloop Healthcare Partners California PC

  • General Practice Physician
  • Palm Desert, CA
  • NPI 1659042331
  NPD
• Openloop Healthcare Partners Colorado, PC

  • General Practice Physician
  • Denver, CO
  • NPI 1912678012
  NPD

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1245832328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 PRIVATEER DR",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294644923",
            "telephone_number": "919-280-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 JOHNNIE DODDS BLVD",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643030",
            "telephone_number": "843-881-0815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12105 W Alameda Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802282832",
            "country_code": "US",
            "telephone_number": "720-613-6050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0995884-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concierge Telehealth LLC (Concierge Therapy)
• Christy L. Cone, M.D.
• Susan Candace Cone, RPH
• Allyrae Conley, LISW-CP
• Ashley Connell
• Victoria Elizabeth Connelly, PT
• Amanda Connolly, LMSW
• Elizabeth Connor, ANP
• Victoria Rose Conroy, DPT
• Helen Tracy Consentino, M.A., LPC

• Family Nurse Practitioner in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.