NPIMap

Individual provider Active NPI

Jerome T Jerome III, MD

  • Family Medicine Physician
  • Leavenworth, WA
National Provider Identifier
1225047566
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00036567 Issued in WA
Practice address
817 Commercial St
Leavenworth, WA 98826-1316
Phone
(509) 548-3431
Fax
(509) 548-2510
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD00036567 WA
Family Medicine Physician 207Q00000X MD00036567 WA Primary

Addresses

Primary practice location

817 Commercial St
Leavenworth, WA 98826-1316

Mailing address

817 Commercial Street
Leavenworth, WA 98826-1316
Phone (509) 548-3431

Other identifiers 4

IdentifierTypeStateIssuer
260172OtherWADEPARTMENT OF LABOR & INDUSTRIES
8240475MedicaidWA
456484OtherWADEPARTMENT OF LABOR & INDUSTRIES
G8894617MedicaidWA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jeromej@cascademedical.org Direct
Direct Messaging Address jeromej@cascademedical.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040402000338 WA Practitioner - Family Practice 7810989357 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chelan County Public Hospital District No. 1Group PAC ID 3971491234, shared by 3 NPIs, 23 clinicians

Practice addresses (Care Compare)

817 Commercial St
Leavenworth, WA 98826-1316
Phone (509) 548-3420

Hospital & facility affiliations

  • Central Washington Health Services Home health agency, Wenatchee, WA, CCN 507029
  • Central Washington Hospital Homecare Services Hospice, Wenatchee, WA, CCN 501516
  • Cascade Medical Center Hospital, Leavenworth, WA, CCN 501313
  • Confluence Health Hospital Hospital, Wenatchee, WA, CCN 500016
  • Cascade Medical Center Nursing home, CCN 50Z313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00036567WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chelan County Public Hospital District No. 1 CurrentSince Aug 22, 2010 Accepting new patients
Chelan County Public Hospital District No. 1 Current Accepting new patients
Chelan County Public Hospital District No. 1 CurrentSince Aug 22, 2010 Accepting new patients
Washington Em-I Medical Services PC Emergency Medicine PastSince Nov 1, 2007 Accepting new patients

Locations

817 Commercial St
Leavenworth, WA 98826
Phone (509) 548-3420

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1225047566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 COMMERCIAL STREET",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988261316",
            "telephone_number": "509-548-3431",
            "fax_number": "509-548-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 COMMERCIAL ST",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988261316",
            "telephone_number": "509-548-3431",
            "fax_number": "509-548-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEROME",
        "first_name": "JEROME",
        "middle_name": "T",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00036567",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00036567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & INDUSTRIES",
            "identifier": "260172",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8240475",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & INDUSTRIES",
            "identifier": "456484",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G8894617",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeromej@cascademedical.org",
            "affiliation": "N",
            "endpointDescription": "provider contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "817 Commercial St",
            "city": "Leavenworth",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988261316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeromej@cascademedical.org",
            "affiliation": "N",
            "endpointDescription": "provider contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "817 Commercial St",
            "city": "Leavenworth",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988261316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Leavenworth, WA

Sources for this page

Verify at the official NPI Registry.