Individual provider Active NPI

Jordan Wesley Tinnell, PA-C

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1629522925
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2174 Issued in KY
Practice address
4130 Dutchmans LN
Ste. 300
Louisville, KY 40207-4713
Phone
(502) 897-1794
Fax
(502) 238-1286
NPI assigned
Aug 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 99077113A IN
Physician Assistant 363A00000X TC492 KY
Physician Assistant 363A00000X 10002178A IN
Medical Physician Assistant 363AM0700X 99077113A IN
Medical Physician Assistant 363AM0700X TC492 KY
Medical Physician Assistant 363AM0700X PA2174 KY
Medical Physician Assistant 363AM0700X 10002178A IN
Surgical Physician Assistant 363AS0400X PA2174 KY
Surgical Physician Assistant 363AS0400X 99077113A IN
Surgical Physician Assistant 363AS0400X TC492 KY
Surgical Physician Assistant 363AS0400X 10002178A IN
Physician Assistant 363A00000X PA2174 KY Primary

Addresses

Primary practice location

4130 Dutchmans LN
Ste. 300
Louisville, KY 40207-4713

Mailing address

4130 Dutchmans LN
Ste. 300
Louisville, KY 40207-4713
Phone (502) 897-1794

Other identifiers 2

IdentifierTypeStateIssuer
7100415730MedicaidKY
300008427MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160929001890 KY Practitioner - Physician Assistant 8325335664 Reassigns benefits to 1 organization
I20170120000996 IN Practitioner - Physician Assistant 8325335664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, shared by 31 NPIs, 2,431 clinicians

Practice addresses (Care Compare)

1373 E State Rd
Madison, IN 47250-7328
Phone (812) 801-0810

1425 State St
Suite 100
New Albany, IN 47150-4976
Phone (812) 542-4921

3900 Kresge Way
Louisville, KY 40207-4681

4002 Kresge Way
Suite 110
Louisville, KY 40207-4605
Phone (502) 928-8700

4130 Dutchmans LN
Suite 200
Louisville, KY 40207-4709
Phone (502) 897-1794

4130 Dutchmans LN
Suite 300
Louisville, KY 40207-4710
Phone (502) 897-1794

Hospital & facility affiliations

  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Physicians' Medical Center LLC Hospital, New Albany, IN, CCN 150172

Merit-based Incentive Payment System (MIPS)

Final score
94.05 of 100Reported as group
Promoting interoperability
93
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10002178AINMDSurgical Physician Assistant
99077113AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc Physician Assistant CurrentSince Sep 1, 2025 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Sep 1, 2025 Accepting new patients
Baptist Health Medical Group Inc Physician Assistant CurrentSince Sep 1, 2025 Accepting new patients

Locations

1373 N State Road 62
Madison, IN 47250
Phone (812) 801-0196

1425 State St
Ste 100
New Albany, IN 47150
Phone (812) 945-2229

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

1901 Campus Pl
Louisville, KY 40299
Phone (502) 253-4911

4130 Dutchmans Ln
Ste 200
Louisville, KY 40207
Phone (502) 238-7293

4130 Dutchmans Ln
Ste 300
Louisville, KY 40207

Interoperability endpoints

  • Direct secure messaging: jordan.tinnell.1@25506.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545782400000",
    "number": "1629522925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 DUTCHMANS LN",
            "address_2": "STE. 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074713",
            "telephone_number": "502-897-1794",
            "fax_number": "502-238-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 DUTCHMANS LN",
            "address_2": "STE. 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074713",
            "telephone_number": "502-897-1794",
            "fax_number": "502-238-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINNELL",
        "first_name": "JORDAN",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-04",
        "last_updated": "2018-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "99077113A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC492",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002178A",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "99077113A",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "TC492",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA2174",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10002178A",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA2174",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "99077113A",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "TC492",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10002178A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100415730",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300008427",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.