Jerry T Staley, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2002023337 Issued in MO

Practice address

55 Middle St
Augusta, ME 04330-5728

Phone

(207) 629-9488

Fax

(207) 622-8796

NPI assigned

Jun 24, 2006

Last updated

Nov 6, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194307200000",
    "number": "1144256843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MIDDLE ST",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043305728",
            "telephone_number": "207-629-9488",
            "fax_number": "207-622-8796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MIDDLE ST",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043305728",
            "telephone_number": "207-629-9488",
            "fax_number": "207-622-8796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "JERRY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2007-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2002023337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00283188",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacia K St. John, NP
• Edith June St. Pierre, CRNA
• Wendy A St. Pierre, PH.D., LCSW
• Gabrielle St.Hilaire, PTA
• Rachel Stadler, PA-C
• Hillary Stanhope
• Sherry Stanley, LPN
• Amber Lee Starke
• State of Maine (Riverview Psychiatric Hospital)
• State of Maine (Oes)

• Physical Medicine & Rehabilitation Physician in Augusta, ME
• Providers in Augusta, ME by specialty
• Physical Medicine & Rehabilitation Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.