Jordan Rullo LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

JORDAN RULLO LLC

Practice address

1433 S 1100 E
Salt Lake City, UT 84105-2434

Phone

(385) 202-4250

NPI assigned

Dec 4, 2017

Last updated

Dec 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jordan Elizabeth Rullo, PHD

Title

Psychologist/Manager

Phone

(612) 991-3042

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 17, 2021 through Jun 17, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512345600000",
    "number": "1881109544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2958 S METROPOLITAN WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841092237",
            "telephone_number": "385-202-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 S 1100 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052434",
            "telephone_number": "385-202-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN RULLO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-04",
        "status": "A",
        "authorized_official_last_name": "RULLO",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PSYCHOLOGIST/MANAGER",
        "authorized_official_telephone_number": "612-991-3042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Nicole Jones
• William Albert Jones, PHARMD
• Nathan David Joos, M.D.
• Ronald Joe Jopling, MD
• Jordan Ridge Family Medicine LLC
• Ali Jordan
• Karen Jordan, CPC-I
• Kelli Christine Jordan, M.D.
• Lori Ann Jordan, PHARMD
• Miya Jordan

• Adult Mental Health Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Adult Mental Health Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.