Active NPI
Jerry M. Davenport, D. O.
- Family Medicine Physician
- Nome, AK
National Provider Identifier
1003935453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4105
- Practice address
- 306 W 5TH Ave
Norton Sound Health Cooperation
Nome, AK 99762 - Phone
- (907) 443-3214
- NPI assigned
- Mar 28, 2007
- Last updated
- Jan 26, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4105 | AK | Primary |
Addresses
Primary practice location
306 W 5TH Ave
Norton Sound Health Cooperation
Nome, AK 99762
Mailing address
9223 Stone Ridge Cir
Sandy, UT 84093-2698
Phone (801) 944-1335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norton Sound Health Corporation | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296000000000",
"number": "1003935453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9223 STONE RIDGE CIR",
"city": "SANDY",
"state": "UT",
"postal_code": "840932698",
"telephone_number": "801-944-1335",
"fax_number": "801-944-1335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 W 5TH AVE",
"address_2": "NORTON SOUND HEALTH COOPERATION",
"city": "NOME",
"state": "AK",
"postal_code": "99762",
"telephone_number": "907-443-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "JERRY",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D. O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2011-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "4105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nome, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.