Active NPI
Jordan Lee Nordquist, MD
- Child & Adolescent Psychiatry Physician
- Johnstown, CO
National Provider Identifier
1679835615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- DR.0064502
- Practice address
- 4901 Thompson Pkwy
Johnstown, CO 80534-6426 - Phone
- (303) 338-4545
- NPI assigned
- Jun 14, 2012
- Last updated
- Jun 17, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 565422 | TX | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 10033 | SD | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | DR.0064502 | CO | Primary |
Addresses
Primary practice location
4901 Thompson Pkwy
Johnstown, CO 80534-6426
Mailing address
10350 E Dakota Ave
Denver, CO 80247-1314
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029064 | Other | CO | KAISER COMMERCIAL NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 565422 | TX | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Healthcare | Current | Accepting new patients | |
| Rosebud Indian Health Service | Current | Accepting new patients | |
| Eagle Butte Indian Health Service Hospital | Current | Accepting new patients | |
| Comprehensive Healthcare | Current | Accepting new patients | |
| Rosebud Indian Health Service | Current | Accepting new patients | |
| Quentin N Burdick Comprehensive Health Care Facility | Current | Accepting new patients | |
| Haaku Health | Past | Accepting new patients |
Locations
1300 Hospital Loop
Belcourt, ND 58316
4100 W 150th St
#3
Cleveland, OH 44135
402 S 4th Ave
Yakima, WA 98902
Phone (509) 575-3874
Interoperability endpoints
- jordan.nordquist@avera.sdhealthlink.net
Organizations & group practices 7
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.
-
- Community/Behavioral Health Agency
- Yakima, WA
- NPI 1073527453
-
- Methadone Clinic
- Yakima, WA
- NPI 1588871693
-
- Public Health or Welfare Agency
- Eagle Butte, SD
- NPI 1558395848
-
- Rural Acute Care Hospital
- Belcourt, ND
- NPI 1952346934
-
dba Rosebud Indian Health Service Hospital
- General Acute Care Hospital
- Rosebud, SD
- NPI 1194757369
-
- Ambulatory Surgical Clinic/Center
- Rosebud, SD
- NPI 1790955128
-
- Health Service Clinic/Center
- San Fidel, NM
- NPI 1962384438
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1679835615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10350 E DAKOTA AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802471314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 THOMPSON PKWY",
"city": "JOHNSTOWN",
"state": "CO",
"postal_code": "805346426",
"telephone_number": "303-338-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDQUIST",
"first_name": "JORDAN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "565422",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "SD",
"license": "10033",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CO",
"license": "DR.0064502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "029064",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "CAREQUALITY",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "4901 Thompson Pkwy",
"city": "Johnstown",
"state": "CO",
"country_code": "US",
"postal_code": "805346426",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Johnstown, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.