Active NPI
Jerry J Gross, D.O.
- Internal Medicine Physician
- Marysville, CA
National Provider Identifier
1386647709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20A4868
- Practice address
- 5730 Packard Ave
Ste 600
Marysville, CA 95901-7118 - Phone
- (530) 741-6245
- Fax
- (530) 741-9274
- NPI assigned
- May 31, 2005
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20A4868 | CA | Primary |
Addresses
Primary practice location
5730 Packard Ave
Ste 600
Marysville, CA 95901-7118
Mailing address
5730 Packard Ave
Ste 600
Marysville, CA 95901-7118
Phone (530) 741-6245
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX48680 | Medicaid | CA |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4868 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327968000000",
"number": "1386647709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5730 PACKARD AVE",
"address_2": "STE 600",
"city": "MARYSVILLE",
"state": "CA",
"postal_code": "959017118",
"telephone_number": "530-741-6245",
"fax_number": "530-741-9274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5730 PACKARD AVE",
"address_2": "STE 600",
"city": "MARYSVILLE",
"state": "CA",
"postal_code": "959017118",
"telephone_number": "530-741-6245",
"fax_number": "530-741-9274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "JERRY",
"middle_name": "J",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2012-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "20A4868",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX48680",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marysville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.