Jerry A Miles, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401005996 Issued in VA

Practice address

26317 W Washington Street
Building 110
Petersburg, VA 23803

Phone

(804) 524-7257

Fax

(804) 524-6496

NPI assigned

Nov 29, 2006

Last updated

Jan 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547164800000",
    "number": "1255408548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26317 W WASHINGTON STREET",
            "address_2": "P.O. BOX 4030",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238032727",
            "telephone_number": "804-524-7257",
            "fax_number": "804-524-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26317 W WASHINGTON STREET",
            "address_2": "BUILDING 110",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23803",
            "telephone_number": "804-524-7257",
            "fax_number": "804-524-6496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8659 Sudley Rd",
            "address_purpose": "LOCATION",
            "city": "Manassas",
            "state": "VA",
            "postal_code": "201104588",
            "country_code": "US",
            "telephone_number": "703-659-1472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILES",
        "first_name": "JERRY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2019-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401005996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.