Active NPI
Jerome W Janda, DO
- Family Medicine Physician
- Cedar Rapids, IA
National Provider Identifier
1144208752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02966
- Practice address
- 6911 C Ave NE
Cedar Rapids, IA 52402-1349 - Phone
- (319) 832-1463
- Fax
- (319) 832-4469
- NPI assigned
- Jan 4, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02966 | IA | Primary |
Addresses
Primary practice location
6911 C Ave NE
Cedar Rapids, IA 52402-1349
Mailing address
6911 C Ave NE
Cedar Rapids, IA 52402-1349
Phone (319) 832-1463
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0801168212 | Other | IA | RR MEDICARE |
| 1128744 | Medicaid | IA | |
| 2128744 | Medicaid | IA | |
| 1144208752 | Medicaid | IA | |
| 080080079 | Other | IA | RR MEDICARE |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02966 | IA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337212800000",
"number": "1144208752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6911 C AVE NE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524021349",
"telephone_number": "319-832-1463",
"fax_number": "319-832-4469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6911 C AVE NE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524021349",
"telephone_number": "319-832-1463",
"fax_number": "319-832-4469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANDA",
"first_name": "JEROME",
"middle_name": "W",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2012-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "02966",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "0801168212",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1128744",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2128744",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1144208752",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "080080079",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.