Shane Jordan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

019466 Issued in NY

Practice address

80 Maiden LN Ste 900
New York, NY 10038-4811

Phone

(917) 261-4414

Fax

(917) 261-4420

NPI assigned

Feb 10, 2016

Last updated

Aug 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Eden Health Medical of Il LTD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1083297469
  NPD (past)

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1982062576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MAIDEN LN STE 900",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384811",
            "telephone_number": "917-261-4414",
            "fax_number": "917-261-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAIDEN LN STE 900",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384811",
            "telephone_number": "917-261-4414",
            "fax_number": "917-261-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-10",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parker Jordan, LMSW
• Patricia Jordan, PHD
• Rebecca Kim Jordan
• Sarah E Jordan
• Sarah Eileen Jordan, NP
• Suzanne Jordan, DPT
• Thomas Jordan, PH.D.
• Victoria S. Jordan, L.C.S.W.
• Jordanne Sculler Licensed Mental Health Counselor
• Kristan Jorde

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.