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JORDAN ALEXA JACKSON PT, DPT, SCS
Complete NPI Record 1700579968
Physical Therapist - Sports in Kansas City, KS

NPI Status: Active since June 01, 2023

Contact Information

1801 N 98TH ST
KANSAS CITY, KS
ZIP 66111
Phone: (913) 264-3000
Fax: (816) 302-9939

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Provider Gender Code
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Is Sole Proprietor
  29. Healthcare Provider Taxonomy Group 1
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1700579968. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1700579968
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: JORDAN
The first name of the provider, if the provider is an individual.
Provider Middle Name: ALEXA
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Credential Text: PT, DPT, SCS
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider First Line Business Mailing Address: 2401 GILLHAM RD
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Business Mailing Address City Name: KANSAS CITY
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address State Name: MO
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Postal Code: 641084619
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Telephone Number: 8167015200
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Fax Number: 8163029939
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 1801 N 98TH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: KANSAS CITY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: KS
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 661111869
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9132643000
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8163029939
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/1/2023
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/25/2024
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 2251S0007X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 11-07296
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: KS
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 9/25/2024