NPIMap

Individual provider Active NPI

Jordan Carlock, DO

  • Family Medicine Physician
  • Newburgh, IN
National Provider Identifier
1992185870
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02004884A Issued in IN
Practice address
8077 Rose Hill Dr
Newburgh, IN 47630-2811
Phone
(812) 853-7363
NPI assigned
Jun 4, 2015
Last updated
Jun 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02004884A IN Primary

Addresses

Primary practice location

8077 Rose Hill Dr
Newburgh, IN 47630-2811

Mailing address

8077 Rose Hill Dr
Newburgh, IN 47630-2811

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jordan.carlock.1@7598.direct.athenahealth.com St Mary's Medical Group, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160819000448 IN Practitioner - Family Practice 2860704129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians

Practice addresses (Care Compare)

801 Saint Marys Dr
505E
Evansville, IN 47714-0528
Phone (812) 491-3236

8077 Rose Hill Dr
Newburgh, IN 47630-2811
Phone (812) 853-7363

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary's Medical Group, LLC Family Medicine CurrentSince Jul 30, 2018 Accepting new patients
St Mary's Medical Group, LLC CurrentSince Jul 30, 2018 Accepting new patients
St. Mary's Health, Inc Family Medicine Past Accepting new patients

Locations

3277 Liberty Blvd
#A
Boonville, IN 47601
Phone (812) 485-6940

100 S Rosenberger Ave
Ste A200
Evansville, IN 47712
Phone (812) 401-0500

1332 Lincoln Ave
Evansville, IN 47714
Phone (812) 476-4362

14020 Old State Rd
Ste A100
Evansville, IN 47725
Phone (812) 469-4700

3700 Bellemeade Ave
Ste 202
Evansville, IN 47714
Phone (812) 437-2737

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

100 St Marys Epworth Xing
Ste B100
Newburgh, IN 47630
Phone (812) 469-8300

8077 Rose Hill Dr
Newburgh, IN 47630
Phone (812) 853-7363

Interoperability endpoints

  • Direct secure messaging: jordan.carlock.1@7598.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1992185870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8077 ROSE HILL DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8077 ROSE HILL DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302811",
            "telephone_number": "812-853-7363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLOCK",
        "first_name": "JORDAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004884A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jordan.carlock.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Mary's Medical Group, LLC",
            "address_1": "8077 Rose Hill Dr",
            "city": "Newburgh",
            "state": "IN",
            "country_code": "US",
            "postal_code": "476302811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.