Jerry Demmert

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

606 Hill Rd
Ketchikan, AK 99901-5343

Phone

(907) 202-8727

Fax

(907) 885-6613

NPI assigned

Dec 1, 2020

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Resilient Youth & Community (Ryc)

  • Community/Behavioral Health Agency
  • Ketchikan, AK
  • NPI 1316563026
  NPD

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1306441027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7475",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999012475",
            "telephone_number": "907-202-8727",
            "fax_number": "907-885-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HILL RD",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015343",
            "telephone_number": "907-202-8727",
            "fax_number": "907-885-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMMERT",
        "first_name": "JERRY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021118",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1584706",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Ann Davis, BS
• Randolph Clark Davis, D.C.
• Katharine Davison
• Russell A Degroote, M.D.
• Michael John Dellaneve, HS3
• John Steven Dempsey
• Virginia Detjen
• David Dettinger
• Cheryl Dewitt
• Division of Alaskan Pioneer Homes

• All providers in Ketchikan, AK
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.