Active NPI
Mireille Joseph Jerome, MD- PA
- Family Medicine Physician
- Mesa, AZ
National Provider Identifier
1174378673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10398
- Practice address
- 6859 E Rembrandt Ave Ste 117
Mesa, AZ 85212-3630 - Phone
- (754) 422-5700
- NPI assigned
- Apr 19, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1780 | PR | |
| Family Medicine Physician | 207Q00000X | 10398 | AZ | Primary |
Addresses
Primary practice location
6859 E Rembrandt Ave Ste 117
Mesa, AZ 85212-3630
Mailing address
6859 E Rembrandt Ave Ste 117
Mesa, AZ 85212-3630
Phone (754) 422-5700
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
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10398 | AZ | MD | Family Medicine Physician |
| 1780 | PR | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727568000000",
"number": "1174378673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6859 E REMBRANDT AVE STE 117",
"city": "MESA",
"state": "AZ",
"postal_code": "852123630",
"telephone_number": "754-422-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6859 E REMBRANDT AVE STE 117",
"city": "MESA",
"state": "AZ",
"postal_code": "852123630",
"telephone_number": "754-422-5700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOSEPH JEROME",
"first_name": "MIREILLE",
"name_prefix": "Dr.",
"credential": "MD- PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-19",
"last_updated": "2024-09-29",
"certification_date": "2024-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PR",
"license": "1780",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "10398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.