Jordan M Edelen, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2072 Issued in KY

Practice address

908 Dupont Rd
Louisville, KY 40207-4602

Phone

(502) 749-7909

Fax

(502) 749-9397

NPI assigned

Nov 12, 2015

Last updated

Mar 20, 2018By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• First Stop Urgent Care Broadway PSC

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1104132687

  Physician Assistant

  NPD (past)
• First Stop Urgent Care Center PSC

  • Family Medicine Physician
  • La Grange, KY
  • NPI 1285731497

  Physician Assistant

  NPD (past)
• First Stop Urgent Care Dupont PSC

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1740501931

  Physician Assistant

  NPD (past)
• Komg-Louisville Region Inc.

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1588132203

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1851764807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST",
            "address_2": "SUITE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021434",
            "telephone_number": "502-749-7909",
            "fax_number": "502-749-9397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 DUPONT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074602",
            "telephone_number": "502-749-7909",
            "fax_number": "502-749-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELEN",
        "first_name": "JORDAN",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-12",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100375380",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lynn Edds
• Melissa Dawn Edds, PA-C
• Steven Edds, DO
• Martha E. Eddy, APRN
• Christopher J Edelen, DMD, MS
• Lindsay Edelen, TCADC
• Meredith Marie Edelen, LMFT LCSW
• Stephen J. Edelen, CRNA
• Edelson and Associates, Inc.
• Richard I Edelson, PH.D

• Physician Assistant in Louisville, KY
• Providers in Louisville, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.