Individual provider Active NPI

Jordan Vold, PA-C

  • Medical Physician Assistant
  • Madison, WI
National Provider Identifier
1922383769
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
7612 Issued in WI
Practice address
1102 S Park St
Madison, WI 53715-1708
Phone
(608) 263-3111
NPI assigned
Oct 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085004186 IL
Medical Physician Assistant 363AM0700X 7612 WI Primary

Addresses

Primary practice location

1102 S Park St
Madison, WI 53715-1708

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other practice location 1

1221 E State St
Rockford, IL 61104-2231
Phone (815) 972-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210104000840 IL Practitioner - Physician Assistant 4880854322 Reassigns benefits to 1 organization
I20240507001799 WI Practitioner - Physician Assistant 4880854322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, shared by 24 NPIs, 1,134 clinicians

Practice addresses (Care Compare)

1221 E State St
Rockford, IL 61104-2231
Phone (815) 972-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085004186ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Centers, Inc. CurrentSince Apr 1, 2024 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 8, 2021 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Feb 8, 2021 Accepting new patients

Locations

1601 Parkview Ave
#S200C
Rockford, IL 61107

1221 E State St
Rockford, IL 61104
Phone (815) 972-1000

1601 Parkview Ave
Rockford, IL 61107
Phone (815) 395-0600

1102 S Park St
Madison, WI 53715
Phone (608) 263-3111

2901 W Beltline Hwy
Ste 120
Madison, WI 53713
Phone (608) 443-5500

2202 S Park St
Madison, WI 53713
Phone (608) 443-5480

Interoperability endpoints

  • Direct secure messaging: jvold97111@uihealth.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1922383769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151708",
            "telephone_number": "608-263-3111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 E State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611042231",
            "country_code": "US",
            "telephone_number": "815-972-1000",
            "fax_number": "815-972-1086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VOLD",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-12",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085004186",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "7612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.