Active NPI
Jerome J Porter
- Social Worker
- Deland, FL
National Provider Identifier
1073822862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 676191796
- Practice address
- 719 E New St
Deland, FL 32724-5811 - Phone
- (386) 738-1891
- NPI assigned
- Sep 28, 2010
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 676191796 | FL | Primary |
Addresses
Primary practice location
719 E New St
Deland, FL 32724-5811
Mailing address
719 E New St
Deland, FL 32724-5811
Phone (386) 738-1891
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 676191796 | Medicaid | FL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 676191796 | FL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1073822862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 E NEW ST",
"city": "DELAND",
"state": "FL",
"postal_code": "327245811",
"telephone_number": "386-738-1891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 E NEW ST",
"city": "DELAND",
"state": "FL",
"postal_code": "327245811",
"telephone_number": "386-738-1891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JEROME",
"middle_name": "J",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-28",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "FL",
"license": "676191796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "676191796",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.