Jordan Jack

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

68243 Issued in CA

Practice address

604 Pearl St
Monterey, CA 93940-3070

Phone

(831) 647-3000

NPI assigned

Sep 9, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1528469681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 PEARL ST",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939403070",
            "telephone_number": "831-647-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 PEARL ST",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939403070",
            "telephone_number": "831-647-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-09",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "68243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTEREY COUNTY BEHAVIORAL HEALTH",
            "identifier": "INTERN MENTAL HEALTH",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larissa Isabella
• Yabalah Israel
• Gerard S Issvoran, DO
• J. Anthony Shaheen MD Inc
• J. Mark Bayless, DMD, Inc.
• Jaya Jacobs, PT
• Eric M Jacobson, M.D.
• Jessica Jacobson
• Joel Paul Jacobson, MD
• Jacqueline Rappahahn, DDS, Inc.

• Clinical Social Worker in Monterey, CA
• Providers in Monterey, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; 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.

Verify at the official NPI Registry.