Active NPI
Edgar Jerome James, LMSW
- Social Worker
- Mattydale, NY
National Provider Identifier
1255111563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 121516
- Practice address
- 112 Endres Dr Apt 2
Mattydale, NY 13211-1134 - Phone
- (229) 539-6873
- NPI assigned
- Oct 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 121516 | NY | Primary |
Addresses
Primary practice location
112 Endres Dr Apt 2
Mattydale, NY 13211-1134
Mailing address
112 Endres Dr Apt 2
Mattydale, NY 13211-1134
Phone (229) 539-6873
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 |
|---|---|---|---|
| 121516 | NY | MD | Social Worker |
Interoperability endpoints
- edgar.james.p1@direct.valerahealth.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1255111563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 ENDRES DR APT 2",
"city": "MATTYDALE",
"state": "NY",
"postal_code": "132111134",
"telephone_number": "229-539-6873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 ENDRES DR APT 2",
"city": "MATTYDALE",
"state": "NY",
"postal_code": "132111134",
"telephone_number": "229-539-6873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMES",
"first_name": "EDGAR",
"middle_name": "JEROME",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-03",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "121516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattydale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.