Individual provider Active NPI

Lisa R Jordan, CNP

  • Family Nurse Practitioner
  • Lima, OH
National Provider Identifier
1356650055
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP.11764 Issued in OH
Practice address
1550 N Main St
Lima, OH 45801-2823
Phone
(419) 516-0327
Fax
(419) 225-8878
NPI assigned
Sep 28, 2010
Last updated
Apr 25, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP.11764 OH Primary

Addresses

Primary practice location

1550 N Main St
Lima, OH 45801-2823

Mailing address

329 N West St
Lima, OH 45801-4332
Phone (419) 221-3072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP.11764OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gray Derm PLLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Lima Memorial Professional Corporation Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1356650055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 N WEST ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014332",
            "telephone_number": "419-221-3072",
            "fax_number": "419-549-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N MAIN ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458012823",
            "telephone_number": "419-516-0327",
            "fax_number": "419-225-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "LISA",
        "middle_name": "R",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-28",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "CNP.11764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

Verify at the official NPI Registry.