Jordan Zane Tacktill, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

0103301083 Issued in VA

Practice address

222 Walnut Ave SW
Roanoke, VA 24016-4723

Phone

(540) 344-3668

NPI assigned

May 25, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Podiatry

Education

Barry University School of Podiatric Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, shared by 17 NPIs, 1,921 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital Hospital, Silver Spring, MD, CCN 210004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Ambulatory Surgical Clinic/Center
  • MC Lean, VA
  • NPI 1073678637

  DC

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Ambulatory Surgical Clinic/Center
  • Woodbridge, VA
  • NPI 1114677572
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Lansdowne, VA
  • NPI 1861552721
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Ambulatory Surgical Clinic/Center
  • Largo, MD
  • NPI 1366781700

  DC

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Ambulatory Surgical Clinic/Center
  • Gaithersburg, MD
  • NPI 1497023188

  DC

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Ambulatory Surgical Clinic/Center
  • Kensington, MD
  • NPI 1578638425

  DC

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Annapolis, MD
  • NPI 1952461816

  DC

  Medicare reassignment NPD
• Foot and Ankle Associates of Southwest Virginia, P.C.

  • Foot & Ankle Surgery Podiatrist
  • Salem, VA
  • NPI 1841220530
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • MC Lean, VA
  • NPI 1376815472
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Ashburn, VA
  • NPI 1699893537
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD

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

• Holy Cross Health, Inc

  • General Acute Care Hospital
  • Silver Spring, MD
  • NPI 1669417838
  Care Compare affiliation
• Holy Cross Health, Inc.

  • Clinical Medical Laboratory
  • Silver Spring, MD
  • NPI 1831574284

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1942560727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WALNUT AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164723",
            "telephone_number": "540-344-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WALNUT AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164723",
            "telephone_number": "540-344-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKTILL",
        "first_name": "JORDAN",
        "middle_name": "ZANE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-25",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3534",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103301083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "1221 Mercantile Ln",
            "city": "Largo",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207745374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Foot & Ankle Surgery Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.