Active NPI
Jordan Ray Noble, DNP, APRN, AGACNP-BC
- Acute Care Nurse Practitioner
- San Diego, CA
National Provider Identifier
1891310538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 95014440
- Practice address
- 4077 Fifth Ave
San Diego, CA 92103-2105 - Phone
- (312) 402-5335
- NPI assigned
- Jun 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 209021013 | IL | |
| Gerontology Nurse Practitioner | 363LG0600X | 209.021013 | IL | |
| Acute Care Nurse Practitioner | 363LA2100X | 95014440 | CA | Primary |
Addresses
Primary practice location
4077 Fifth Ave
San Diego, CA 92103-2105
Mailing address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone (619) 686-3789
Other practice location 1
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (312) 402-5335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250204000242 | CA | Order and Referring Only - Nurse Practitioner | 0648700872 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209021013 | IL | MD | Acute Care Nurse Practitioner |
| 209.021013 | IL | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients |
Locations
4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245
Interoperability endpoints
- jnoble381472@scrippshlth.medalliesdirect.net
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.
-
- General Acute Care Hospital
- San Diego, CA
- NPI 1487928891
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747872000000",
"number": "1891310538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4077 FIFTH AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032105",
"telephone_number": "619-686-3789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4077 FIFTH AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032105",
"telephone_number": "312-402-5335"
}
],
"practiceLocations": [
{
"address_1": "5841 S Maryland Ave",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606371443",
"country_code": "US",
"telephone_number": "312-402-5335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOBLE",
"first_name": "JORDAN",
"middle_name": "RAY",
"credential": "DNP, APRN, AGACNP-BC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-09",
"last_updated": "2025-05-22",
"certification_date": "2025-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "IL",
"license": "209021013",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IL",
"license": "209.021013",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "95014440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.