Active NPI
Jerald Mullersman, MD
- Clinical Pathology Physician
- Mountain Home, TN
National Provider Identifier
1245415033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology Physician
- License
- MD24976
- Practice address
- Building 119
Mountain Home, TN 37684-0699 - Phone
- (423) 439-7029
- NPI assigned
- Dec 31, 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 |
|---|---|---|---|---|
| Clinical Pathology Physician | 207ZC0006X | MD24976 | TN | Primary |
Addresses
Primary practice location
Building 119
Mountain Home, TN 37684-0699
Mailing address
PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 433-6039
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3401897 | Other | TN | LAB MEDICARE PIN |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD24976 | TN | MD | Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351123200000",
"number": "1245415033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 699",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376840699",
"telephone_number": "423-433-6039",
"fax_number": "423-433-6060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BUILDING 119",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376840699",
"telephone_number": "423-439-7029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLERSMAN",
"first_name": "JERALD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-31",
"last_updated": "2012-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "207ZC0006X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology",
"state": "TN",
"license": "MD24976",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LAB MEDICARE PIN",
"identifier": "3401897",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.