Active NPI
Deandre Jordan
- Rehabilitation Practitioner
- Las Vegas, NV
National Provider Identifier
1790107134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 3690 N Rancho Dr
3692 N. Rancho Dr.
Las Vegas, NV 89130-3182 - Phone
- (702) 749-6263
- NPI assigned
- Jan 18, 2014
- Last updated
- Jan 18, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | NU | Primary |
Addresses
Primary practice location
3690 N Rancho Dr
3692 N. Rancho Dr.
Las Vegas, NV 89130-3182
Mailing address
4965 Athens Bay PL
N Las Vegas, NV 89031-0971
Phone (702) 817-3094
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225400000X | Medicaid | NV |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390003200000",
"number": "1790107134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4965 ATHENS BAY PL",
"city": "N LAS VEGAS",
"state": "NV",
"postal_code": "890310971",
"telephone_number": "702-817-3094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3690 N RANCHO DR",
"address_2": "3692 N. RANCHO DR.",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891303182",
"telephone_number": "702-749-6263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "DEANDRE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-18",
"last_updated": "2014-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "225400000X",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.