Individual provider Active NPI

Jordan E Goad, PA-C

  • Medical Physician Assistant
  • Medina, OH
National Provider Identifier
1639560857
Registry record updated Oct 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
50.004232RX Issued in OH
Practice address
5783 Wooster Pike
Medina, OH 44256-8816
Phone
(330) 725-0569
Fax
(330) 662-0258
NPI assigned
Feb 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 50.004232RX OH Primary

Addresses

Primary practice location

5783 Wooster Pike
Medina, OH 44256-8816

Mailing address

5783 Wooster Pike
Medina, OH 44256-8816
Phone (330) 725-0569

Other practice location 1

2865 Center Rd Ste 5
Brunswick, OH 44212-2324
Phone (330) 725-0569

Other practice location 2

128 E Milltown Rd Ste 208
Wooster, OH 44691-1276
Phone (330) 725-0569

Other practice location 3

5779 Wooster Pike
Medina, OH 44256-8816
Phone (330) 725-0569

Other practice location 4

300 Weatherstone Dr Ste 106
Wadsworth, OH 44281-7833
Phone (330) 725-0569

Other identifiers 1

IdentifierTypeStateIssuer
0125673MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20150417000635 OH Practitioner - Physician Assistant 4082932397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HMT Dermatology Associates Inc.Group PAC ID 6709787989, 17 clinicians

Practice addresses (Care Compare)

128 E Milltown Rd
Suite 208
Wooster, OH 44691-1276
Phone (330) 725-0569

5779 Wooster Pike
Medina, OH 44256-8816
Phone (330) 725-0569

5783 Wooster Pike
Medina, OH 44256-8816
Phone (330) 725-0569

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.004232RXOHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Health Center Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1423526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604102400000",
    "number": "1639560857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5783 WOOSTER PIKE",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568816",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5783 WOOSTER PIKE",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568816",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2865 Center Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "OH",
            "postal_code": "442122324",
            "country_code": "US",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 E Milltown Rd Ste 208",
            "address_purpose": "LOCATION",
            "city": "Wooster",
            "state": "OH",
            "postal_code": "446911276",
            "country_code": "US",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5779 Wooster Pike",
            "address_purpose": "LOCATION",
            "city": "Medina",
            "state": "OH",
            "postal_code": "442568816",
            "country_code": "US",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Weatherstone Dr Ste 106",
            "address_purpose": "LOCATION",
            "city": "Wadsworth",
            "state": "OH",
            "postal_code": "442817833",
            "country_code": "US",
            "telephone_number": "330-725-0569",
            "fax_number": "330-662-0258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOAD",
        "first_name": "JORDAN",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-10",
        "last_updated": "2020-10-31",
        "certification_date": "2020-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.004232RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0125673",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.