Active NPI
Jerry James Clayville, CRNP
- Pediatric Nurse Practitioner
- Salisbury, MD
National Provider Identifier
1215010939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R057554
- Practice address
- 223 Phillip Morris Dr
Salisbury, MD 21804-1923 - Phone
- (410) 548-1747
- Fax
- (410) 548-3783
- NPI assigned
- Oct 24, 2006
- Last updated
- Oct 24, 2018
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R057554 | MD | Primary |
Addresses
Primary practice location
223 Phillip Morris Dr
Salisbury, MD 21804-1923
Mailing address
PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
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 |
|---|---|---|---|
| R057554 | MD | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1215010939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1978",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218021978",
"telephone_number": "410-749-1015",
"fax_number": "410-749-0654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 PHILLIP MORRIS DR",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218041923",
"telephone_number": "410-548-1747",
"fax_number": "410-548-3783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAYVILLE",
"first_name": "JERRY",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "R057554",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119591300",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, MD
- Civic Health Services LLC (Mt Hermon Discount Pharmacy)
- Rachel Zipporah Clark, CRNP
- Amanda Clarke, CRNP
- Nattile Clarke, FNP-BC
- Donald E. Clayton, CRNP-F
- Clearway Anesthesia Services NE LLC
- Clearway Surgery Center of Salisbury LLC
- William W. Clendenen, D.O.
- Christopher M Clifford, CRNA
- James Leo Clifford, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.