NPIMap

Individual provider Active NPI

Jordan Stores, PA-C

  • Physician Assistant
  • Orange Park, FL
National Provider Identifier
1710424254
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113597 Issued in FL
Practice address
1544 County Road 220 Ste 100
Orange Park, FL 32003-4991
Phone
(904) 223-2340
Fax
(904) 637-7991
NPI assigned
Jan 23, 2017
Last updated
Jun 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA9113597 FL Primary

Addresses

Primary practice location

1544 County Road 220 Ste 100
Orange Park, FL 32003-4991

Mailing address

1959 Moorings Cir
Middleburg, FL 32068-6645
Phone (904) 662-0310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210828000080 FL Practitioner - Physician Assistant 3678857760 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

653 W 8TH St
Jacksonville, FL 32209-6511

655 W 8TH St
Jacksonville, FL 32209-6511

655 W 8TH St
Jacksonville, FL 32231-6511
Phone (904) 244-6340

76011 William Burgess Rd
Yulee, FL 32097-5428
Phone (904) 427-8590

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9113597FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Nov 4, 2024 Accepting new patients
The Emory Clinic Inc CurrentSince Mar 13, 2017 Accepting new patients
Solantic of Jacksonville, LLC CurrentSince Jul 17, 2021 Accepting new patients
Cep America LLC CurrentSince Jun 21, 2023 Accepting new patients
Cep America LLC CurrentSince Jun 21, 2023 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Nov 4, 2024 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Nov 4, 2024 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

4201 Belfort Rd
Jacksonville, FL 32216
Phone (904) 268-5561

7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603

1544 County Road 220
Ste 100
Orange Park, FL 32003
Phone (904) 830-9009

76011 William Burgess Blvd
Fl 1
Yulee, FL 32097

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: jstores751644@direct.shands.ufl.edu

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1710424254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 MOORINGS CIR",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686645",
            "telephone_number": "904-662-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1544 COUNTY ROAD 220 STE 100",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320034991",
            "telephone_number": "904-223-2340",
            "fax_number": "904-637-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORES",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-23",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.