Individual provider Active NPI

Patricia Jordan, LICSW

  • Clinical Social Worker
  • Port Angeles, WA
National Provider Identifier
1285029835
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
118 E 8TH St
Port Angeles, WA 98362-6129
Phone
(360) 457-0431
Fax
(360) 457-0491
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

118 E 8TH St
Port Angeles, WA 98362-6129

Mailing address

118 E 8TH St
Port Angeles, WA 98362-6129
Phone (360) 457-0431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230120002061 WA Practitioner - Clinical Social Worker 1658742101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peninsula Behavioral HealthGroup PAC ID 7416845870, 19 clinicians

Practice addresses (Care Compare)

118 E 8TH St
Port Angeles, WA 98362-6129
Phone (360) 457-0431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peninsula Behavioral Health CurrentSince Oct 13, 2022 Accepting new patients
Core Health Past Accepting new patients

Locations

118 E 8th St
Port Angeles, WA 98362
Phone (360) 457-0431

112 E 8th St
Ste A
Port Angeles, WA 98362

500 W Fir St
Sequim, WA 98382

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/peninsulabehavioral/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1285029835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "PATRICIA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.