LORI JORDAN BACK (FNP-C) – Family Nurse Practitioner, NPI 1639934102
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
24,243 NURSE PRACTITIONER in FL
Provider Addresses for LORI JORDAN BACK (FNP-C)
4540 SOUTHSIDE BLVD STE 401
JACKSONVILLE, FL 322165488
Phone: (904) 977-6380
Fax: (800) 983-7668
Type: Mailing
5880 49TH ST N UNIT N-201
ST PETERSBURG, FL 337092150
Phone: (727) 300-0405
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $194.
Total Amount is formed as General ($194) + Research ($0) + Ownership ($0) = $194.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: Solventum Corporation ($194).
Total Amount
$194
General + Research + Ownership
Payments
4
Total payment records
General Amount
$194
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Solventum Corporation | $194 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-04-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240401001286 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32216)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | IN | |
| Family Practice | FL |
Reviews
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