Jordan Pierson Garner Roberts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085005576 Issued in IL

Practice address

800 W Diversey Pkwy # 200
Chicago, IL 60614-1412

Phone

(312) 796-7121

NPI assigned

Aug 25, 2015

Last updated

Sep 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jordan Garner-Roberts Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Brightland Health LLC

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1952815656
  NPD (past)

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1801263801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W DIVERSEY PKWY # 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141412",
            "telephone_number": "312-796-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W DIVERSEY PKWY # 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141412",
            "telephone_number": "312-796-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JORDAN",
        "middle_name": "PIERSON GARNER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-25",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10061",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "GARNER-ROBERTS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• J. Romaine Roberts, MD
• Jan N Roberts, MD
• Jared Roberts, M.D.
• Jean Roberts, LCSW
• Joan Margaret Roberts, CNP
• Katherine Roberts
• Kathy Louise Roberts, FNP
• Katrina P Roberts
• Keishonna Roberts
• Keith A Roberts, OD

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.