Active NPI
Jason Yamil Perez I
- Student in an Organized Health Care Education/Training Program
- Brockton, MA
National Provider Identifier
1225452097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- S63796894
- Practice address
- 142 Crescent St
Second Floor
Brockton, MA 02302-3104 - Phone
- (508) 941-0005
- Fax
- (508) 427-6915
- NPI assigned
- Feb 13, 2014
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | S63796894 | MA | Primary |
Addresses
Primary practice location
142 Crescent St
Second Floor
Brockton, MA 02302-3104
Mailing address
142 Crescent Street
Second Floor
Brockton, MA 02302
Phone (508) 941-0005
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 |
|---|---|---|---|
| S63796894 | MA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392249600000",
"number": "1225452097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 CRESCENT STREET",
"address_2": "SECOND FLOOR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02302",
"telephone_number": "508-941-0005",
"fax_number": "508-427-6915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 CRESCENT ST",
"address_2": "SECOND FLOOR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023104",
"telephone_number": "508-941-0005",
"fax_number": "508-427-6915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "JASON",
"middle_name": "YAMIL",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-13",
"last_updated": "2014-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "S63796894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.