Active NPI
Jerry G Mayes, DMD
- General Practice Dentistry
- London, KY
National Provider Identifier
1194855866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4620
- Practice address
- 828 South Main Street
London, KY 40741 - Phone
- (606) 878-7251
- Fax
- (606) 878-1285
- NPI assigned
- Mar 6, 2007
- Last updated
- Jul 8, 2007
- 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 | 4620 | KY | Primary |
Addresses
Primary practice location
828 South Main Street
London, KY 40741
Mailing address
828 South Main Street
London, KY 40741
Phone (606) 878-7251
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60046208 | Medicaid | KY |
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 |
|---|---|---|---|
| 4620 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jerry G. Mayes, PSC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194855866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 SOUTH MAIN STREET",
"city": "LONDON",
"state": "KY",
"postal_code": "40741",
"telephone_number": "606-878-7251",
"fax_number": "606-878-1285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 SOUTH MAIN STREET",
"city": "LONDON",
"state": "KY",
"postal_code": "40741",
"telephone_number": "606-878-7251",
"fax_number": "606-878-1285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYES",
"first_name": "JERRY",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "4620",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60046208",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in London, KY
- Marymount Medical Center Physician Services
- Marymount Medical Center Physician Services
- Antwon Mason, LMT
- Amanda Baker Mastin, PHARMD
- Jackie D Maxey, MD
- Denise Maynes, APRN
- Andrew Spencer McCormick, RPH
- April Louise McDonald, APRN
- Carolyn F McFarland, APRN, FNP, PMHNP-BC
- Dorothy Suzanne McGehee, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.