Active NPI
Walter Jerome Jordan
- Home Health Agency
- St Petersburg, FL
National Provider Identifier
1447733712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 235565
- Practice address
- 600 40TH St N Apt 111
St Petersburg, FL 33713-6339 - Phone
- (727) 657-8392
- NPI assigned
- Sep 12, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 235565 | FL | Primary |
Addresses
Primary practice location
600 40TH St N Apt 111
St Petersburg, FL 33713-6339
Mailing address
600 40TH St N Apt 111
St Petersburg, FL 33713-6339
Phone (727) 657-8392
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 235565 | Other | FL | AGENCY FOR HEALTH CARE ADMINISTRATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 235565 | FL | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536710400000",
"number": "1447733712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 40TH ST N APT 111",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337136339",
"telephone_number": "727-657-8392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 40TH ST N APT 111",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337136339",
"telephone_number": "727-657-8392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "WALTER",
"middle_name": "JEROME",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-12",
"last_updated": "2018-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "235565",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY FOR HEALTH CARE ADMINISTRATION",
"identifier": "235565",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.