Individual provider Active NPI

John Sewell Gerometta, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Michigan City, IN
National Provider Identifier
1285627174
Registry record updated Mar 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
01040073A Issued in IN
Practice address
301 W Homer St
St Anthony Memorial Hospital
Michigan City, IN 46360-4358
Phone
(219) 861-8669
Fax
(219) 877-1081
NPI assigned
Aug 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 01040073A IN Primary

Addresses

Primary practice location

301 W Homer St
St Anthony Memorial Hospital
Michigan City, IN 46360-4358

Mailing address

113 E 4TH St
Michigan City, IN 46360-3301
Phone (219) 879-2208

Other identifiers 3

IdentifierTypeStateIssuer
2017120002OtherINCIGNA
82425OtherINBC/BS
5260529OtherINCCN

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01040073AINMDAnatomic Pathology & Clinical Pathology Physician

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1285627174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E 4TH ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463603301",
            "telephone_number": "219-879-2208",
            "fax_number": "219-873-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W HOMER ST",
            "address_2": "ST ANTHONY MEMORIAL HOSPITAL",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463604358",
            "telephone_number": "219-861-8669",
            "fax_number": "219-877-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEROMETTA",
        "first_name": "JOHN",
        "middle_name": "SEWELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01040073A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2017120002",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "82425",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "5260529",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.