Jordan Dale Whitaker, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TC870 Issued in KY

Practice address

1770 Lake Cumberland Rd
Mount Vernon, KY 40456-8431

Phone

(606) 256-7488

Fax

(606) 256-8036

NPI assigned

Sep 25, 2019

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Physician Assistant

Education

Lincoln Memorial University Medical Department, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Lexington Hospital, Lexington, KY, CCN 180103

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Baptist Health Medical Group Inc

  dba Dawson Springs Rural Health Clinic

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  Medicare reassignment Care Compare group NPD
• Rockcastle County Hospital, Inc.

  dba Rockcastle Regional Hospital and Respiratory Care Center

  • General Acute Care Hospital
  • Mount Vernon, KY
  • NPI 1104890714

  Physician Assistant

  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  dba Princeton Rural Health Clinic

  • Rural Health Clinic/Center
  • Princeton, KY
  • NPI 1447728043
  NPD
• Rockcastle County Hospital, Inc.

  dba Rockcastle Quick Care Clinic

  • Rural Health Clinic/Center
  • Mount Vernon, KY
  • NPI 1396263000
  NPD
• Rockcastle County Hospital, Inc.

  dba Rockcastle Pediatrics and Adolescents

  • Rural Health Clinic/Center
  • Mount Vernon, KY
  • NPI 1205177912
  NPD (past)

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

• Baptist Healthcare System, Inc

  dba Baptist Health Lexington

  • General Acute Care Hospital
  • Lexington, KY
  • NPI 1538244918
  Care Compare affiliation

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1659922250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 LAKE CUMBERLAND RD",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404568431",
            "telephone_number": "606-256-7488",
            "fax_number": "606-256-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 LAKE CUMBERLAND RD",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404568431",
            "telephone_number": "606-256-7488",
            "fax_number": "606-256-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "JORDAN",
        "middle_name": "DALE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• True Self Counseling and Wellness
• Charles Jeffrey Tyree, PTA
• Victory Behavioral Health
• Victory Counseling
• Walgreen Co (Walgreens #17180)
• Justin Allen Williams, D.O.
• Youngs Pharmacy

• Physician Assistant in Mount Vernon, KY
• Providers in Mount Vernon, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.