Individual provider Active NPI

William Jordan, MD

  • Pediatrics Physician
  • Harvey, IL
National Provider Identifier
1649320680
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036112051 Issued in IL
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

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
036112051MedicaidIL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050222000094 IL Practitioner - Pediatric Medicine 4284687005 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036112051ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Friend Family Health Center Inc CurrentSince Jan 1, 2013 Accepting new patients
Friend Family Health Center Inc Current Accepting new patients
Friend Family Health Center, Inc CurrentSince Jan 1, 2013 Accepting new patients
Family Christian Health Center CurrentSince Feb 1, 2022 Accepting new patients
Family Christian Health Center CurrentSince Feb 1, 2022 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.

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

Verify at the official NPI Registry.