Active NPI
William Jordan, MD
- Pediatrics Physician
- Harvey, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036112051
- Practice address
- 31 W 155TH St
Harvey, IL 60426-3556 - Phone
- (708) 596-5177
- Fax
- (708) 596-5518
- NPI assigned
- Jan 11, 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 |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 036112051 | IL | |
| Pediatrics Physician | 208000000X | 036112051 | IL | Primary |
Addresses
Primary practice location
31 W 155TH St
Harvey, IL 60426-3556
Mailing address
31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 596-5177
Other practice location 1
180 Harvester Dr Ste 110
Burr Ridge, IL 60527
Phone (773) 834-4064
Other practice location 2
800 E 55th St
Chicago, IL 60615-4906
Phone (773) 702-0660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036112051 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036112051 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Friend Family Health Center Inc | Current | Accepting new patients | |
| Friend Family Health Center Inc | Current | Accepting new patients | |
| Friend Family Health Center, Inc | Current | Accepting new patients | |
| Family Christian Health Center | Current | Accepting new patients | |
| Family Christian Health Center | Current | Accepting new patients |
Locations
800 E 55th St
Chicago, IL 60615
Phone (773) 702-2193
1522 E 63rd St
Chicago, IL 60637
Phone (773) 795-2260
31 W 155th St
Harvey, IL 60426
Phone (708) 596-5177
19767 Torrence Ave
Lynwood, IL 60411
Phone 7085965177 ext. 8793
Organizations & group practices 5
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.
-
- Federally Qualified Health Center (FQHC)
- Harvey, IL
- NPI 1093855736
-
- Federally Qualified Health Center (FQHC)
- Chicago, IL
- NPI 1578560090
-
- Federally Qualified Health Center (FQHC)
- Harvey, IL
- NPI 1013744325
-
- Federally Qualified Health Center (FQHC)
- Chicago, IL
- NPI 1477175305
-
- Federally Qualified Health Center (FQHC)
- Chicago, IL
- NPI 1457330870
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721260800000",
"number": "1649320680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 W 155TH ST",
"city": "HARVEY",
"state": "IL",
"postal_code": "604263556",
"telephone_number": "708-596-5177",
"fax_number": "708-596-5518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 W 155TH ST",
"city": "HARVEY",
"state": "IL",
"postal_code": "604263556",
"telephone_number": "708-596-5177",
"fax_number": "708-596-5518"
}
],
"practiceLocations": [
{
"address_1": "180 Harvester Dr Ste 110",
"address_purpose": "LOCATION",
"city": "Burr Ridge",
"state": "IL",
"postal_code": "60527",
"country_code": "US",
"telephone_number": "773-834-4064",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "800 E 55th St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606154906",
"country_code": "US",
"telephone_number": "773-702-0660",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JORDAN",
"first_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2024-07-18",
"certification_date": "2024-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "IL",
"license": "036112051",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036112051",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036112051",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Harvey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.