Individual provider Active NPI

Roger K Kerley, MD

  • Internal Medicine Physician
  • Mount Airy, NC
National Provider Identifier
1093787061
Registry record updated Feb 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24602 Issued in NC
Practice address
865 W Lake Dr
Mt Airy, NC 27030-2157
Phone
(336) 719-6100
Fax
(336) 719-2313
NPI assigned
Feb 3, 2006
Last updated
Feb 1, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24602 NC Primary

Addresses

Primary practice location

865 W Lake Dr
Mt Airy, NC 27030-2157

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 719-6100

Other identifiers 1

IdentifierTypeStateIssuer
8948548MedicaidNC

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

LicenseStateTypeSpecialty
24602NCMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359676800000",
    "number": "1093787061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-719-6100",
            "fax_number": "336-719-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 W LAKE DR",
            "city": "MT AIRY",
            "state": "NC",
            "postal_code": "270302157",
            "telephone_number": "336-719-6100",
            "fax_number": "336-719-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERLEY",
        "first_name": "ROGER",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2013-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "24602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8948548",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Airy, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.