Jordan Brook Mockta, ACSM-EP

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

License

1059346 Issued in AZ

Practice address

1500 E Cedar Ave Ste 52
Flagstaff, AZ 86004-1643

Phone

(928) 773-1245

Fax

(928) 773-9429

NPI assigned

Apr 6, 2022

Last updated

Apr 11, 2022By the provider in NPPES

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1548901176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 E. CORTLAND BLVD 190",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86004",
            "telephone_number": "928-255-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E CEDAR AVE STE 52",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041643",
            "telephone_number": "928-773-1245",
            "fax_number": "928-773-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCKTA",
        "first_name": "JORDAN",
        "middle_name": "BROOK",
        "name_prefix": "Mr.",
        "credential": "ACSM-EP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "",
            "desc": "Clinical Exercise Physiologist",
            "state": "AZ",
            "license": "1059346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D04316506",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "DataEncryption",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1500 E Cedar Ave Ste 52",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Exercise Physiologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Clinical Exercise Physiologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.