Active NPI
Jerry Ray Jones
- Adult Health Nurse Practitioner
- Baraboo, WI
National Provider Identifier
1174288948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 4704219859
- Practice address
- 1670 South Blvd
Baraboo, WI 53913-2937 - Phone
- (608) 356-9318
- NPI assigned
- Nov 5, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 4704219859 | MI | Primary |
Addresses
Primary practice location
1670 South Blvd
Baraboo, WI 53913-2937
Mailing address
1670 South Blvd
Baraboo, WI 53913-2937
Phone (734) 660-2025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636070400000",
"number": "1174288948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1670 SOUTH BLVD",
"city": "BARABOO",
"state": "WI",
"postal_code": "539132937",
"telephone_number": "734-660-2025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 SOUTH BLVD",
"city": "BARABOO",
"state": "WI",
"postal_code": "539132937",
"telephone_number": "608-356-9318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "JERRY",
"middle_name": "RAY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-05",
"last_updated": "2021-11-05",
"certification_date": "2021-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MI",
"license": "4704219859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.