Active NPI
Jerry Mounts, D.D.S.
- General Practice Dentistry
- Matewan, WV
National Provider Identifier
1164824868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2741
- Practice address
- 1 Mate Street
Matewan, WV 25678-0537 - Phone
- (304) 426-4161
- Fax
- (304) 426-4162
- NPI assigned
- Sep 24, 2014
- Last updated
- Sep 24, 2014
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2741 | WV | Primary |
Addresses
Primary practice location
1 Mate Street
Matewan, WV 25678-0537
Mailing address
PO Box 537
Matewan, WV 25678-0537
Phone (304) 426-4161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0137275000 | Medicaid | WV |
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 |
|---|---|---|---|
| 2741 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jerry Mounts DDS, Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Matewan, WV
- NPI 1285728188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411516800000",
"number": "1164824868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 537",
"city": "MATEWAN",
"state": "WV",
"postal_code": "256780537",
"telephone_number": "304-426-4161",
"fax_number": "304-426-4162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MATE STREET",
"city": "MATEWAN",
"state": "WV",
"postal_code": "256780537",
"telephone_number": "304-426-4161",
"fax_number": "304-426-4162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUNTS",
"first_name": "JERRY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-24",
"last_updated": "2014-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "2741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0137275000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Matewan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.