Active NPI
Barbara Jordan, DO
- Emergency Medicine Physician
- Willoughby, OH
National Provider Identifier
1720049661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 34002925J
- Practice address
- 36000 Euclid Ave
Willoughby, OH 44094 - Phone
- (440) 953-6203
- Fax
- (440) 953-6202
- NPI assigned
- Mar 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 34002925J | OH | Primary |
Addresses
Primary practice location
36000 Euclid Ave
Willoughby, OH 44094
Mailing address
9291 Hidden Glen Dr
Mentor, OH 44060
Phone (440) 974-0557
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0433570 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34002925J | OH | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Emergency Services Inc | Emergency Medicine | Past | Accepting new patients |
| Emergency Physicians Professional Association LTD | Emergency Medicine | Past | Accepting new patients |
| Lake Hospital System, Inc | Family Medicine | Past | Accepting new patients |
| Lake Hospital System, Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Willoughby, OH
- NPI 1518927995
-
- Emergency Medicine Physician
- Phoenix, AZ
- NPI 1114931490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1720049661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9291 HIDDEN GLEN DR",
"city": "MENTOR",
"state": "OH",
"postal_code": "44060",
"telephone_number": "440-974-0557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36000 EUCLID AVE",
"city": "WILLOUGHBY",
"state": "OH",
"postal_code": "44094",
"telephone_number": "440-953-6203",
"fax_number": "440-953-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "BARBARA",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-30",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OH",
"license": "34002925J",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0433570",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willoughby, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.