Individual provider Active NPI

Jordan Diana, AGNP

  • Nurse Practitioner
  • Youngstown, OH
National Provider Identifier
1750952867
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.0029271 Issued in OH
Practice address
7630 Southern Blvd
Youngstown, OH 44512-5633
Phone
(330) 729-8000
NPI assigned
Jul 9, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN.CNP.0029271 OH
Nurse Practitioner 363L00000X APRN.CNP.0029271 OH Primary
Adult Health Clinical Nurse Specialist 364SA2200X APRN.CNP.0029271 OH
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

7630 Southern Blvd
Youngstown, OH 44512-5633

Mailing address

7630 Southern Blvd
Youngstown, OH 44512-5633
Phone (330) 729-8000

Other identifiers 1

IdentifierTypeStateIssuer
0453891MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20210825000598 OH Practitioner - Nurse Practitioner 8123423407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

7629 Market St
Suite 100
Youngstown, OH 44512-6051
Phone (330) 729-8015

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
71.12
Promoting interoperability
100
Improvement activities
40
Cost
75.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Health Services, LLC Nurse Practitioner CurrentSince Sep 1, 2021 Accepting new patients
The Surgery Center at Southwoods, LLC Past Accepting new patients
Southwoods Health at Home, LLC PastSince Sep 1, 2021 Accepting new patients

Locations

7630 Southern Blvd
Youngstown, OH 44512
Phone (330) 729-8000

7629 Market St
Ste 200
Youngstown, OH 44512
Phone (330) 729-8000

100 Debartolo Pl
Ste 200
Youngstown, OH 44512
Phone (330) 965-7828

7629 Market St
Ste 100
Youngstown, OH 44512
Phone (330) 792-0583

7629 Market St
Ste 250
Youngstown, OH 44512
Phone (330) 729-9480

250 Debartolo Pl
Ste C
Youngstown, OH 44512

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1750952867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 SOUTHERN BLVD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125633",
            "telephone_number": "330-729-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7630 SOUTHERN BLVD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125633",
            "telephone_number": "330-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIANA",
        "first_name": "JORDAN",
        "credential": "AGNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0029271",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0029271",
            "primary": true
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.0029271",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0453891",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.