Active NPI
Roy Eugene Kerry, MD
- Specialist
- Greenville, PA
National Provider Identifier
1063579522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD008220E
- Practice address
- 17 6TH Ave
Greenville, PA 16125-1237 - Phone
- (724) 588-2600
- Fax
- (724) 588-6427
- NPI assigned
- Jan 3, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MD008220E | PA | Primary |
Addresses
Primary practice location
17 6TH Ave
Greenville, PA 16125-1237
Mailing address
17 6TH Ave
Greenville, PA 16125-1237
Phone (724) 588-2600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007258300001 | Medicaid | PA | |
| 0162158 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2008 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD008220E | PA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | 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 and National Provider Directory roles.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063579522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 6TH AVE",
"city": "GREENVILLE",
"state": "PA",
"postal_code": "161251237",
"telephone_number": "724-588-2600",
"fax_number": "724-588-6427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 6TH AVE",
"city": "GREENVILLE",
"state": "PA",
"postal_code": "161251237",
"telephone_number": "724-588-2600",
"fax_number": "724-588-6427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERRY",
"first_name": "ROY",
"middle_name": "EUGENE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "MD008220E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0007258300001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0162158",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.