Active NPI
Shelby Jordan
- Behavior Technician
- Bloomington, IN
National Provider Identifier
1871331397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-264432
- Practice address
- 4101 E 3Rd St
Bloomington, IN 47401-5539 - Phone
- (812) 318-4494
- NPI assigned
- Jul 18, 2024
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-264432 | IN | Primary |
Addresses
Primary practice location
4101 E 3Rd St
Bloomington, IN 47401-5539
Mailing address
2815 E 3Rd St # 1011
Bloomington, IN 47401-5434
Phone (812) 318-4494
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-264432 | IN | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rise Autism LLC | Behavior Technician | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721260800000",
"number": "1871331397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 E 3RD ST # 1011",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474015434",
"telephone_number": "812-318-4494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 E 3RD ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474015539",
"telephone_number": "812-318-4494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "SHELBY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-18",
"last_updated": "2024-07-18",
"certification_date": "2024-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "RBT-23-264432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.