Jordan Taylor Havyar, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4205 Issued in TN

Practice address

3966 Bloomingdale Rd
Kingsport, TN 37660-7004

Phone

(423) 765-0161

NPI assigned

Jun 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jordan Taylor Bacon Former name

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Merit-based Incentive Payment System (MIPS)

Final score

93.67 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

78.91

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 and National Provider Directory roles.

• Gastrointestinal Associates of Northeast Tennessee, PC

  • Gastroenterology Physician
  • Johnson City, TN
  • NPI 1578529632
  Medicare reassignment
• Healthy Sprouts and House Calls, PLLC

  • Pediatrics Physician
  • Kingsport, TN
  • NPI 1942907928
  NPD

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1982228847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3966 BLOOMINGDALE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376607004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3966 BLOOMINGDALE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376607004",
            "telephone_number": "423-765-0161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAVYAR",
        "first_name": "JORDAN",
        "middle_name": "TAYLOR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-05",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "BACON",
            "middle_name": "TAYLOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey L Hatcher, CRNA
• Haun Chiropractic
• Janie Marie Haun, D.C.
• Michael Haun, DC
• Lydia Haurez, LPC-MHSP
• Kirsten Hawbaker
• James R Hawkins, MSW CMSW
• Carol Sue Haworth, APN
• Heather-Marie Douw Hawthorne, BS
• Rosa Leighanne Hayes, FNP

• Physician Assistant in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.