Jerry L Gastineau

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7688 Issued in TN

Practice address

1505 W Elk Ave
Suite 2
Elizabethton, TN 37643-2848

Phone

(423) 543-1261

Fax

(423) 543-7500

NPI assigned

Oct 13, 2006

Last updated

Dec 18, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1124118971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE",
            "address_2": "SUITE 2",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432848",
            "telephone_number": "423-543-1261",
            "fax_number": "423-543-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE",
            "address_2": "SUITE 2",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432848",
            "telephone_number": "423-543-1261",
            "fax_number": "423-543-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASTINEAU",
        "first_name": "JERRY",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "TN",
            "license": "MD7688",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "7688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3152032",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "TN0102",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "201575",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4360576",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHNDEERE",
            "identifier": "TN0102",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "201575",
            "identifier": "BLUECROSS",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.