Jordan Marie Moore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.005794RX Issued in OH

Practice address

11100 Euclid Ave
Cleveland, OH 44106-1716

Phone

(216) 844-2273

NPI assigned

Nov 20, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

Physician Assistant

Education

Lake Erie College of Osteopathic Medicine, Erie, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Adirondack Medical CenterGroup PAC ID 9638081284, 85 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adirondack Medical Center - Saranac Lake Hospital, Saranac Lake, NY, CCN 330079

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Adirondack Medical Center

  • General Practice Physician
  • Saranac Lake, NY
  • NPI 1245446533
  Medicare reassignment Care Compare group
• Adirondack Medical Center

  • Surgery Physician
  • Saranac Lake, NY
  • NPI 1871359000
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adirondack Medical Center

  • General Acute Care Hospital
  • Saranac Lake, NY
  • NPI 1699709576
  Care Compare affiliation
• Adirondack Medical Center

  • General Acute Care Hospital
  • Saranac Lake, NY
  • NPI 1851601108
  Care Compare affiliation

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

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1356810303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JORDAN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-20",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005794RX",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "LE-00026012",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MEDICAL BOARD PRESCRIPTIVE AUTHORITY NUMBER",
            "identifier": "LE-00026012",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice Moore
• Jennifer Lynn Moore, CNP
• John J Moore, MD
• Joi N Moore, SWT
• Jonathan Moore
• Joshua Lee Moore, DPM
• Juanita Moore
• Katharine T. Moore, LCSW
• Katherine Louise Moore, AU.D.
• Kathleen Anne Moore, RNC NNP

• Physician Assistant in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; 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.