Jordan Vandyke

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070024599 Issued in IL

Practice address

200 Health Care Dr
Greenville, IL 62246-1154

Phone

(618) 664-2626

NPI assigned

Nov 18, 2019

Last updated

Nov 18, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• JDV Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Saint Louis, MO
  • NPI 1861274284

  Physical Therapist

  Medicare reassignment NPD
• Compass Capital LLC

  • Physical Therapy Clinic/Center
  • Chesterfield, MO
  • NPI 1104772581
  NPD (past)

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574035200000",
    "number": "1841836533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CHELSEA RD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTH CARE DR",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461154",
            "telephone_number": "618-664-2626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 Veterans Ave",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "IL",
            "postal_code": "624713303",
            "country_code": "US",
            "telephone_number": "618-283-9040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDYKE",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-18",
        "last_updated": "2019-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070024599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carleta Trout, B.S.
• Tammy Sue Tulacro, LPT/LAT
• Stacy L Turner, MA, ATC
• Adah Elizabeth Van Eeckhout, OTR/L
• Susan Elizabeth Vandenbergh, P.T.
• Damon T Vincent, MD
• Vituity - Illinois Infectious Disease Specialists, P.C.
• Billy Lee Viviano, DC
• Mikaella Mari Walker, M.A., LCPC
• Watsons Drug Store Inc (Watsons Drug Store)

• Physical Therapist in Greenville, IL
• Providers in Greenville, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.