Individual provider Active NPI

Andrew A Jordan, MD

  • Ophthalmology Physician
  • Fargo, ND
National Provider Identifier
1992723563
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4579 Issued in ND
Practice address
1717 University Dr S
Fargo, ND 58103-4939
Phone
(701) 461-5000
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 4579 ND Primary
Ophthalmology Physician 207W00000X 48153 MN

Addresses

Primary practice location

1717 University Dr S
Fargo, ND 58103-4939

Mailing address

1717 University Dr S
Fargo, ND 58103-4939
Phone (701) 461-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060123000834 MN Practitioner - Ophthalmology 1850345299 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Washington School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health of Northern MinnesotaGroup PAC ID 5597725168, 349 clinicians

Practice addresses (Care Compare)

110 7TH St W
Park Rapids, MN 56470-1872
Phone (218) 699-3121

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

1656 Central St W
Bagley, MN 56621-4357
Phone (218) 694-2384

Hospital & facility affiliations

  • Sanford Bemidji Medical Center Hospital, Bemidji, MN, CCN 240100

Merit-based Incentive Payment System (MIPS)

Final score
86.56 of 100Reported as group
Quality
74.25
Promoting interoperability
100
Improvement activities
40
Cost
76.16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48153MNMDOphthalmology Physician
4579NDMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients

Locations

1656 Central St W
Ste A
Bagley, MN 56621
Phone (218) 694-2442

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1992723563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034939",
            "telephone_number": "701-461-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034939",
            "telephone_number": "701-461-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ANDREW",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ND",
            "license": "4579",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "48153",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.