Active NPI
Jerry W Brackett, M.D.
- General Practice Physician
- Berea, KY
National Provider Identifier
1033165394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 14390
- Practice address
- 607 Chestnut St
Berea, KY 40403-1514 - Phone
- (859) 582-9331
- Fax
- (606) 789-5600
- NPI assigned
- May 26, 2006
- Last updated
- Jun 15, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 14390 | KY | Primary |
Addresses
Primary practice location
607 Chestnut St
Berea, KY 40403-1514
Mailing address
607 Chestnut St
Berea, KY 40403-1514
Phone (859) 582-9331
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64143902 | Medicaid | KY | |
| 000000059655 | Other | KY | ANTHEM |
| 340002395 | Other | KY | RAILROAD MEDICARE |
| 611139169 | Other | KY | HUMANA |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14390 | KY | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rolling Hills Chiropractic, PSC | Past | Accepting new patients | |
| Validus Health, PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Louisville, KY
- NPI 1982657813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245024000000",
"number": "1033165394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 CHESTNUT ST",
"city": "BEREA",
"state": "KY",
"postal_code": "404031514",
"telephone_number": "859-582-9331",
"fax_number": "606-789-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 CHESTNUT ST",
"city": "BEREA",
"state": "KY",
"postal_code": "404031514",
"telephone_number": "859-582-9331",
"fax_number": "606-789-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKETT",
"first_name": "JERRY",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2009-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "KY",
"license": "14390",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64143902",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000059655",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "340002395",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "611139169",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berea, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.