Active NPI
Jack Edward Myers, P.A.
- Physician Assistant
- Sheldon, IA
National Provider Identifier
1295817237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000618
- Practice address
- 800 Oak St
Sheldon, IA 51201-1242 - Phone
- (712) 324-5356
- Fax
- (712) 324-6515
- NPI assigned
- Oct 19, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000618 | IA | Primary |
Addresses
Primary practice location
800 Oak St
Sheldon, IA 51201-1242
Mailing address
800 Oak St
P.O. Box 10
Sheldon, IA 51201-1242
Phone (712) 324-5356
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0254656 | Medicaid | IA | |
| 0638593 | Medicaid | IA |
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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295817237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 OAK ST",
"address_2": "P.O. BOX 10",
"city": "SHELDON",
"state": "IA",
"postal_code": "512011242",
"telephone_number": "712-324-5356",
"fax_number": "712-324-6515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 OAK ST",
"city": "SHELDON",
"state": "IA",
"postal_code": "512011242",
"telephone_number": "712-324-5356",
"fax_number": "712-324-6515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "JACK",
"middle_name": "EDWARD",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "000618",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0254656",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0638593",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheldon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.