Jordan Black, CPNP-PC
Individual provider Active NPI Pediatric Nurse Practitioner · Town and Country, MO
NPI 1902496540 · NPPES record last updated Jul 10, 2023
Key facts
- NPI
- 1902496540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 2020021017 (MO)
- Practice address
- 13001 N Outer 40 Rd
Town and Country, MO 63017-5941 - Phone
- (314) 454-5437
- NPI assigned
- Jan 18, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210716001383 | MO | Order and Referring Only - Nurse Practitioner | 1456753177 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 2020021017 | MO | Yes |
Addresses
Primary practice location
13001 N Outer 40 Rd
Town and Country, MO 63017-5941
Mailing address
13001 N Outer 40 Rd
Town and Country, MO 63017-5941
Other practice location 1
1 Childrens Pl
Saint Louis, MO 63110-1002
Phone (314) 482-2323
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | jordan.julian@bjc.org | ||
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Town and Country, MO
- Shelby Mauree Beck
- Christine D Berg
- Elizabeth Ann Berry
- Charissa Marie Bickel
- Hollie Scott Bickel
- Lauren Nicole Bremerman
- Gayle Donette Bridgham
- Jasmine Brown
- Katie Bublis
- Diana Lucille Butler
All providers in Town and Country, MO · Pediatric Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.