Jeremy W Jordan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0007579 Issued in CO

Practice address

11711 Collett Ave Apt 531
Riverside, CA 92505-3771

Phone

(707) 540-3712

NPI assigned

Sep 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert Marriott Medical CorpGroup PAC ID 2567531494, 63 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.

• Robert Marriott Medical Corp

  • Surgery Physician
  • El Segundo, CA
  • NPI 1083883938

  CO

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1487378949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 COLLETT AVE APT 531",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053771",
            "telephone_number": "707-540-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11711 COLLETT AVE APT 531",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053771",
            "telephone_number": "707-540-3712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "JEREMY",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0007579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andre Jordan
• Denetrice Carol Jordan
• Desiree Jordan
• Devoneia Jordan
• Heather Nicole Jordan, PA-C
• Landria Alysia Jordan
• Marisa Jordan
• Selina L Jordan, LMFT
• Jacqueline Jordon
• Jorge H. Zamudio DDS Inc.

• Physician Assistant in Riverside, CA
• Providers in Riverside, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.