Andrew D Jordan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025955 Issued in IL

Practice address

214 N Main St
Pontiac, IL 61764-1905

Phone

(815) 842-3550

Fax

(815) 842-2811

NPI assigned

Nov 1, 2006

Last updated

May 19, 2021By the provider in NPPES

Sex

Male

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 IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Associated Dentists, PC

  • General Practice Dentistry
  • Pontiac, IL
  • NPI 1619946878
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1285711572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 N MAIN ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641905",
            "telephone_number": "815-842-3550",
            "fax_number": "815-842-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 N MAIN ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641905",
            "telephone_number": "815-842-3550",
            "fax_number": "815-842-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ANDREW",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J a K Enterprises Inc (Bard Optical)
• J C Purnell MD SC
• Nicole M. Jack, PA-C
• Heather Ann Taylor Jackson, APRN, WHNP-BC
• John W. Rinker
• Kenneth N Jordan, DO
• Arianne M Kaack, PHARMD
• Katie Kennedy
• Misty Kessinger, BS
• Kimberly K Kidner, D.C.

• General Practice Dentistry in Pontiac, IL
• Providers in Pontiac, IL by specialty
• General Practice Dentistry in Illinois

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