NPIMap

Individual provider Active NPI

Michael J Jordan, NP

  • Acute Care Nurse Practitioner
  • Urbana, IL
National Provider Identifier
1932566288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95015046 Issued in CA
Practice address
611 W Park St
Hvi
Urbana, IL 61801-2529
Phone
(217) 904-7000
Fax
(217) 904-7742
NPI assigned
Jan 18, 2016
Last updated
Aug 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95015046 CA
Acute Care Nurse Practitioner 363LA2100X 95015046 CA Primary
Acute Care Nurse Practitioner 363LA2100X 209013781 IL

Addresses

Primary practice location

611 W Park St
Hvi
Urbana, IL 61801-2529

Mailing address

400 Parnassus Ave
# 655
San Francisco, CA 94143-2202
Phone (217) 383-6792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200914002761 CA Practitioner - Nurse Practitioner 1355646423 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95015046CAMDNurse Practitioner
209013781ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco CurrentSince Aug 19, 2020 Accepting new patients
UCSF Medical Group Business Services CurrentSince Aug 19, 2020 Accepting new patients
UCSF Pediatrics Associates CurrentSince Aug 19, 2020 Accepting new patients
UCSF Medical Group Business Services Nurse Practitioner CurrentSince Aug 19, 2020 Accepting new patients
UCSF Dept of Surgery CurrentSince Aug 19, 2020 Accepting new patients
University of California San Francisco CurrentSince Aug 19, 2020 Accepting new patients
Regents of the University of California CurrentSince Aug 19, 2020 Accepting new patients
University of California San Francisco Current Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients
Albany General Hospital Past Accepting new patients
St. Mary's Good Samaritan Hospital, Inc. Past Accepting new patients
Regents of the University of California Past Accepting new patients
University of California San Francisco Past Accepting new patients

Locations

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

3333 California St
#S110
San Francisco, CA 94118
Phone (415) 514-2664

400 Parnassus Ave
#655
San Francisco, CA 94143
Phone (415) 353-2161

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

Interoperability endpoints

  • Direct secure messaging: mjordan127810@direct-ucsfmedicalcenter.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598054400000",
    "number": "1932566288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PARNASSUS AVE",
            "address_2": "# 655",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432202",
            "telephone_number": "217-383-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "HVI",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-904-7000",
            "fax_number": "217-904-7742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-18",
        "last_updated": "2020-08-22",
        "certification_date": "2020-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95015046",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95015046",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209013781",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.