NPIMap

Individual provider Active NPI

Christopher Jordan, MD

  • Sports Medicine (Family Medicine) Physician
  • Mishawaka, IN
National Provider Identifier
1689938664
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
01072993A Issued in IN
Practice address
611 E Douglas Rd Ste 137
Mishawaka, IN 46545-1464
Phone
(574) 335-6214
Fax
(574) 335-6215
NPI assigned
Jun 25, 2012
Last updated
Nov 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 01072993A IN Primary

Addresses

Primary practice location

611 E Douglas Rd Ste 137
Mishawaka, IN 46545-1464

Mailing address

707 Cedar St Ste 405
South Bend, IN 46617-2059

Other practice location 1

611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468
Phone (574) 335-6500

Other practice location 2

1919 Lake Ave Ste 102B
Plymouth, IN 46563-7830
Phone (574) 335-6214

Other identifiers 2

IdentifierTypeStateIssuer
01072993AOtherININ STATE MEDICAL LICENSE
201110900MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141231000156 IN Practitioner - Sports MedicinePractitioner - Internal MedicinePractitioner - Family Practice 7012156060 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1915 Lake Ave
Plymouth, IN 46563-9366
Phone (574) 948-4000

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Current Accepting new patients
Saint Joseph Regional Medical Center, Inc. CurrentSince Jan 9, 2023 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Family Medicine Current Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc CurrentSince Aug 29, 2016 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc CurrentSince May 1, 2020 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. CurrentSince Aug 29, 2016 Accepting new patients
Healthlinc, Inc PastSince May 15, 2023 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. Family Medicine Past Accepting new patients

Locations

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500

611 E Douglas Rd
Ste 137
Mishawaka, IN 46545
Phone (574) 335-6214

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

611 E Douglas Rd
Ste 407
Mishawaka, IN 46545
Phone (574) 335-6500

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

1919 Lake Ave
Ste 102B
Plymouth, IN 46563
Phone (574) 335-6214

510 W Adams St
Ste 150
Plymouth, IN 46563
Phone (574) 335-3987

707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328

616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100

Interoperability endpoints

  • Direct secure messaging: cjordan1147712@direct.trinity-health.org

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Healthlinc - ValparaisoValparaiso, IN, CCN 151840 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - Michigan CityMichigan City, IN, CCN 151845 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - KnoxKnox, IN, CCN 151851 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - MishawakaMishawaka, IN, CCN 151873 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - Iusb DentalSouth Bend, IN, CCN 151952 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - CentennialSouth Bend, IN, CCN 151025 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - SoutheastSouth Bend, IN, CCN 151026 Federally qualified health center Corporate Director May 15, 2023
Healthlinc LaporteLa Porte, IN, CCN 151052 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - CorporateValparaiso, IN, CCN 151141 Federally qualified health center Corporate Director May 15, 2023
Healthlinc - East Chicago Harbor WestEast Chicago, IN, CCN C51064 Federally qualified health center Corporate Officer
Corporate Director		 May 15, 2023
May 15, 2023
Healthlinc - la Porte PediatricsLa Porte, IN, CCN C51077 Federally qualified health center Corporate Officer
Corporate Director		 May 15, 2023
May 15, 2023
Healthlinc - NewtonMorocco, IN, CCN C51111 Federally qualified health center Corporate Officer
Corporate Director		 Dec 1, 2023
Dec 1, 2023

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 3

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": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1689938664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 405",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 137",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451464",
            "telephone_number": "574-335-6214",
            "fax_number": "574-335-6215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 E Douglas Rd Ste 407",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465451468",
            "country_code": "US",
            "telephone_number": "574-335-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1919 Lake Ave Ste 102B",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465637830",
            "country_code": "US",
            "telephone_number": "574-335-6214",
            "fax_number": "574-335-0772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "CHRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "01072993A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN STATE MEDICAL LICENSE",
            "identifier": "01072993A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201110900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.