Active NPI
Jarom Jardine, DO
- Pediatrics Physician
- Kirtland AFB, NM
National Provider Identifier
1043891575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34.016257
- Practice address
- 2050A 2ND St SE
Kirtland AFB, NM 87117-1873 - Phone
- (505) 846-3200
- NPI assigned
- Apr 16, 2021
- Last updated
- Jul 26, 2024
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34.016257 | OH | Primary |
Addresses
Primary practice location
2050A 2ND St SE
Kirtland AFB, NM 87117-1873
Mailing address
4881 Sugar Maple Dr
Dayton, OH 45433-5529
Phone (937) 522-4784
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34.016257 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1043891575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4881 SUGAR MAPLE DR",
"city": "DAYTON",
"state": "OH",
"postal_code": "454335529",
"telephone_number": "937-522-4784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050A 2ND ST SE",
"city": "KIRTLAND AFB",
"state": "NM",
"postal_code": "871171873",
"telephone_number": "505-846-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARDINE",
"first_name": "JAROM",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-16",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "34.016257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirtland AFB, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.