Active NPI
Jordan Blaine Coulston, M.D
- Internal Medicine Physician
- Gilbert, AZ
National Provider Identifier
1487850004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 43356
- Practice address
- 1900 N Higley Rd
Gilbert, AZ 85234-1604 - Phone
- (480) 543-2034
- Fax
- (480) 543-2647
- NPI assigned
- Jun 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 43356 | AZ | Primary |
Addresses
Primary practice location
1900 N Higley Rd
Gilbert, AZ 85234-1604
Mailing address
1900 N Higley Rd
Gilbert, AZ 85234-1604
Phone (480) 543-2034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120824000760 | AZ | Order and Referring Only - Internal Medicine | 0143346049 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43356 | AZ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290038400000",
"number": "1487850004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 N HIGLEY RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852341604",
"telephone_number": "480-543-2034",
"fax_number": "480-543-2647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 N HIGLEY RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852341604",
"telephone_number": "480-543-2034",
"fax_number": "480-543-2647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COULSTON",
"first_name": "JORDAN",
"middle_name": "BLAINE",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-21",
"last_updated": "2010-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "43356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.