Jordan Rose

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2141 Issued in AL

Practice address

4682 Airport Blvd
Mobile, AL 36608-3124

Phone

(251) 455-4702

NPI assigned

Jul 26, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jordan Doucet Former name

Medicare fee-for-service enrollment

Enrolled in AL

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

University of South Alabama College of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Alabama Family Care, LLCGroup PAC ID 0042754715, 8 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• South Alabama Family Care, LLC

  • Rural Health Clinic/Center
  • Grand Bay, AL
  • NPI 1649028960

  AL

  Medicare reassignment Care Compare group
• Elite Urgent Care LLC

  • Urgent Care Clinic/Center
  • Mobile, AL
  • NPI 1922672245

  AL

  Medicare reassignment
• Elite Urgent Care LLC

  • Urgent Care Clinic/Center
  • Mobile, AL
  • NPI 1588405070
  NPD
• Total Wound Care of Texas LLC

  • Internal Medicine Physician
  • McKinney, TX
  • NPI 1225741937
  NPD (past)

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1396418596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 GOLMON CIR",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365267050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4682 AIRPORT BLVD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366083124",
            "telephone_number": "251-455-4702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "2141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "DOUCET",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Angela Roney, M.S., LPC
• Lakeshia Seneitha Roper
• Hunter Lee Carmon Rosamond, RBT
• Rose Counseling Center
• Amanda A. Rose, CRSS
• Melanie Rose, MD
• Zachary Michael Rose, PHARMD
• Michelle Marie Rosenberg
• David C Ross, M.D.
• Robert Charles Ross, MD

• All providers in Mobile, AL
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.