Individual provider Active NPI

Jordan Ross Waldman, CRNA

  • Certified Registered Nurse Anesthetist
  • Brooklyn, NY
National Provider Identifier
1417566076
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
696827 Issued in NY
Practice address
121 Dekalb Ave
Brooklyn, NY 11201-5493
Phone
(718) 250-8000
NPI assigned
Jul 29, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 696827-01 NY
Certified Registered Nurse Anesthetist 367500000X 696827 NY Primary

Addresses

Primary practice location

121 Dekalb Ave
Brooklyn, NY 11201-5493

Mailing address

3100 Denton Dr
Merrick, NY 11566-5115
Phone (516) 244-5824

Other practice location 1

560 W 169th St
New York, NY 10032-3913
Phone (212) 305-4318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231009000140 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264887462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia LLPGroup PAC ID 7719885771, 427 clinicians

Practice addresses (Care Compare)

121 Dekalb Ave
Brooklyn, NY 11201-5425
Phone (718) 250-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
696827-01NYMDCritical Care Medicine Registered Nurse
696827NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia LLP CurrentSince Aug 21, 2023 Accepting new patients

Locations

7 Southwoods Blvd
Ste 4
Albany, NY 12211

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1417566076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 DENTON DR",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115665115",
            "telephone_number": "516-244-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015493",
            "telephone_number": "718-250-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "560 W 169th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323913",
            "country_code": "US",
            "telephone_number": "212-305-4318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "JORDAN",
        "middle_name": "ROSS",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-29",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NY",
            "license": "696827-01",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "696827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.