Active NPI
Jordan Taylor Mahoney, PA-C
- Physician Assistant
- Port St Lucie, FL
National Provider Identifier
1871178749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9113759
- Practice address
- 1400 SE Goldtree Dr Ste 103
Port St Lucie, FL 34952-7582 - Phone
- (772) 335-8446
- NPI assigned
- Mar 12, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9113759 | FL | Primary |
Addresses
Primary practice location
1400 SE Goldtree Dr Ste 103
Port St Lucie, FL 34952-7582
Mailing address
2486 SE Tiffany Ave
Port St Lucie, FL 34952-6560
Phone (816) 517-7495
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9113759 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palm Beach General Surgery LLC | Past | Accepting new patients |
Interoperability endpoints
- jordan.burch@hca4.eclinicaldirectplus.com
Organizations & group practices 1
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.
-
- Surgery Physician
- Atlantis, FL
- NPI 1710040266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1871178749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2486 SE TIFFANY AVE",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349526560",
"telephone_number": "816-517-7495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 SE GOLDTREE DR STE 103",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349527582",
"telephone_number": "772-335-8446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONEY",
"first_name": "JORDAN",
"middle_name": "TAYLOR",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-12",
"last_updated": "2021-12-07",
"certification_date": "2021-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9113759",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.