Jordan M De Lisle

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OP61570577 Issued in WA

Practice address

1321 Colby Ave Ste B400
Everett, WA 98201-1665

Phone

(425) 297-5234

NPI assigned

Mar 24, 2021

Last updated

Nov 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pacmed ClinicsGroup PAC ID 2466350657, 211 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdelisle1720885@wm.providencedirect.org

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.

• Pacmed Clinics

  dba Pacific Medical Centers

  • Multi-Specialty Clinic/Center
  • Seattle, WA
  • NPI 1013061217
  Medicare reassignment Care Compare group
• Providence Health & Services- Washington

  dba PMG NW Wa

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment NPD
• Pacmed Clinics

  • Multi-Specialty Clinic/Center
  • Renton, WA
  • NPI 1720023641
  NPD
• Providence Health & Services - Washington

  dba PMG NW WA Marysville Clinic

  • Family Medicine Physician
  • Marysville, WA
  • NPI 1063663458

  Internal Medicine

  NPD
• Pacmed Clinics

  dba Pacific Medical Centers - Infusion/Therapy

  • Infusion Therapy Clinic/Center
  • Seattle, WA
  • NPI 1124567474
  NPD (past)
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  NPD (past)

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1881271286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 COLBY AVE STE B400",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 COLBY AVE STE B400",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011665",
            "telephone_number": "425-297-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LISLE",
        "first_name": "JORDAN",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OP61570577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Therese Nicole De la Torre, RN
• Aina Alba Aitana De Lapparent
• Jessica A De Larwelle, MSW
• April Joy Ruiz De Leon, RDH
• Stephanie Marie De Leon
• Michelina De Simone, LMP
• Nora Ann De Souza, PHARMD
• Micaela Lorraine Clauson Dea, DDS
• Antonia Lee Christina Dean, DPT
• Emily Marie Dean

• Internal Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.