Individual provider Active NPI

Jeffrey Stanton Gerdes, D.C.

  • Chiropractor
  • Raleigh, NC
National Provider Identifier
1205089703
Registry record updated Sep 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3985 Issued in NC
Practice address
1207 Ridge Rd.
Raleigh, NC 27607
Phone
(919) 809-7839
Fax
(919) 809-7839
NPI assigned
Oct 28, 2008
Last updated
Sep 7, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3985 NC Primary

Addresses

Primary practice location

1207 Ridge Rd.
Raleigh, NC 27607

Mailing address

1207 Ridge Rd.
Raleigh, NC 27607
Phone (919) 809-7839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120912000078 NC Practitioner - Chiropractic 9032367362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1207 Ridge Rd
Raleigh, NC 27607-6834
Phone (919) 809-7839

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Chirocare and Rehab Inc. Chiropractor CurrentSince Aug 4, 2012 Accepting new patients

Locations

1207 Ridge Rd
Raleigh, NC 27607
Phone (919) 809-7839

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": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1205089703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 RIDGE RD.",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27607",
            "telephone_number": "919-809-7839",
            "fax_number": "919-809-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 RIDGE RD.",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27607",
            "telephone_number": "919-809-7839",
            "fax_number": "919-809-7839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERDES",
        "first_name": "JEFFREY",
        "middle_name": "STANTON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-28",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.