NPIMap

Individual provider Active NPI

Jerad William Cox

  • Pharmacist
  • Bozeman, MT
National Provider Identifier
1174129753
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PHA-PHA-LIC-65963 Issued in MT
Practice address
1400 N 19TH Ave
Bozeman, MT 59718-3647
Phone
(406) 586-3550
Fax
(406) 586-0788
NPI assigned
Dec 8, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PHA-PHA-LIC-65963 MT Primary

Addresses

Primary practice location

1400 N 19TH Ave
Bozeman, MT 59718-3647

Mailing address

1400 N 19TH Ave
Bozeman, MT 59718-3647
Phone (406) 586-3550

Other identifiers 1

IdentifierTypeStateIssuer
P8471OtherIDPHARMACIST

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL jerad.cox@stores.sfdc.com Direct

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

LicenseStateTypeSpecialty
PHA-PHA-LIC-65963MTMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho State University Health Center Past Accepting new patients
Smith'S Food & Drug Centers Inc PastSince Dec 13, 2020 Accepting new patients
Smiths Food & Drug Centers Inc PastSince Dec 13, 2020 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1174129753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N 19TH AVE",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597183647",
            "telephone_number": "406-586-3550",
            "fax_number": "406-586-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N 19TH AVE",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597183647",
            "telephone_number": "406-586-3550",
            "fax_number": "406-586-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COX",
        "first_name": "JERAD",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "PHA-PHA-LIC-65963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST",
            "identifier": "P8471",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jerad.cox@stores.sfdc.com",
            "affiliation": "N",
            "endpointDescription": "store url",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Kroger",
            "address_1": "1400 N 19th Ave",
            "city": "Bozeman",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597183647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.