Active NPI
Matthew Jerrell
- Pharmacist
- Scottsburg, IN
National Provider Identifier
1083384093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26029233A
- Practice address
- 1618 W McClain Ave
Scottsburg, IN 47170-1161 - Phone
- (812) 752-5589
- NPI assigned
- Sep 20, 2021
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26029233A | IN | Primary |
Addresses
Primary practice location
1618 W McClain Ave
Scottsburg, IN 47170-1161
Mailing address
411 1/2 W Main St
Madison, IN 47250-3736
Phone (812) 595-6848
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 |
|---|---|---|---|
| 26029233A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632096000000",
"number": "1083384093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 1/2 W MAIN ST",
"city": "MADISON",
"state": "IN",
"postal_code": "472503736",
"telephone_number": "812-595-6848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1618 W MCCLAIN AVE",
"city": "SCOTTSBURG",
"state": "IN",
"postal_code": "471701161",
"telephone_number": "812-752-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERRELL",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-20",
"last_updated": "2021-09-20",
"certification_date": "2021-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26029233A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scottsburg, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.