JORDAN CREEK FAMILY MEDICAL CLINIC PC
NPI 1356378772
Family Medicine in West Des Moines, IA
About Jordan Creek Family Medical Clinic Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JORDAN CREEK FAMILY MEDICAL CLINIC PC (NPI 1356378772) is a healthcare organization registered as a family medicine in West Des Moines, Iowa and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through February 28, 2027 and lists Basil Saadi Hassan, President/ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jordan Creek Family Medical Clinic Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Jordan Creek Family Medical Clinic PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 16D1056664
Jordan Creek Family Medicine Clinic, PC · West Des Moines, IAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jordan Creek Family Medical Clinic PC's NPI number?
The NPI number for Jordan Creek Family Medical Clinic PC is 1356378772. It was assigned to this organization in the NPPES registry on June 28, 2006.
Where is Jordan Creek Family Medical Clinic PC located?
Jordan Creek Family Medical Clinic PC is located at 230 S 68th St Suite 220, West Des Moines, IA 50266. The listed phone number is (515) 457-8517.
What is Jordan Creek Family Medical Clinic PC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Jordan Creek Family Medical Clinic PC enrolled in Medicare?
Yes. Jordan Creek Family Medical Clinic PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Jordan Creek Family Medical Clinic PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Jordan Creek Family Medical Clinic PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Jordan Creek Family Medical Clinic PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 16D1056664) is associated with this NPI, valid through February 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Jordan Creek Family Medical Clinic PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jordan Creek Family Medical Clinic Pc · NPI 1356378772
Family Medicine organization in West Des Moines, Iowa. Organization record, active in the CMS NPPES registry since June 28, 2006.
## Identity
- **NPI:** 1356378772 (Entity type: Organization)
- **Enumerated:** June 28, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Basil Hassan, PRESIDENT/CEO
## Practice location
- **Address:** 230 S 68TH ST, SUITE 220, West Des Moines, IA 50266-8176
- **Phone:** (515) 457-8517
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1356378772) · Data from the CMS NPPES public registry.