Peter Stevan Jerome, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

P4321 Issued in TX

Practice address

700 E Marshall Ave
Longview, TX 75601-5580

Phone

(903) 315-1488

Fax

(903) 315-1656

NPI assigned

Jun 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in ID, TX, NC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ECHIAA

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.

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  Sleep Medicine

  Medicare reassignment NPD
• Houston Pulmonary Medicine Associates PA

  • Pulmonary Disease Physician
  • Houston, TX
  • NPI 1881712628
  Medicare reassignment NPD
• DLP Western Carolina Physician Practices LLC

  • Internal Medicine Physician
  • Sylva, NC
  • NPI 1609281641

  Pulmonary Disease

  Medicare reassignment NPD
• Vibra Physicians LLC

  • Hospitalist Physician
  • Johnstown, CO
  • NPI 1659705424

  ID

  Medicare reassignment NPD
• Renaissance ICU Group

  • Critical Care Medicine (Internal Medicine) Physician
  • Edinburg, TX
  • NPI 1740715820
  Medicare reassignment
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• DLP Western Carolina Physician Practices LLC

  • Diagnostic Radiology Physician
  • Clyde, NC
  • NPI 1932925062
  NPD
• Healtheast Medical Research Institute

  dba HealthEast Vadnais Heights Clinic

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  NPD
• Ascension Medical Group-Fox Valley Wisconsin, Inc

  dba Ascension Medical Group

  • Multi-Specialty Clinic/Center
  • Neenah, WI
  • NPI 1730126392
  NPD (past)
• Ascension Medical Group-Fox Valley Wisconsin, Inc

  • Cardiovascular Disease Physician
  • Appleton, WI
  • NPI 1831890177
  NPD (past)
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1396740668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 1ST DR NW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559122941",
            "telephone_number": "507-433-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015580",
            "telephone_number": "903-315-1488",
            "fax_number": "903-315-1656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 1st Dr NW",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "MN",
            "postal_code": "559122941",
            "country_code": "US",
            "telephone_number": "507-433-7351",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 E Hawaii Ave",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836866011",
            "country_code": "US",
            "telephone_number": "208-463-3000",
            "fax_number": "208-463-3035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEROME",
        "first_name": "PETER",
        "middle_name": "STEVAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "ND",
            "license": "12731",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MN",
            "license": "51376",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "23793",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "M-12784",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "ID",
            "license": "M-12784",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "P4321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00849680",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P02137176",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "393948001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31692500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey M. Shea, MD, PA (Pulmonary - Critical Care Associates of East Texas)
• Alison Jensen
• Barbara Yantz Jereb, M.S., LPC
• Ronald J. Jereb, PHD
• Patrice L Jernegons, LCDC
• Jess Xpress, LLC
• Jessica Anderson PLLC (Dalmatian Place)
• Maanasa Jetty, M.D
• JM Health Care Company LLC (All American Home Care)
• John E Petty DC PC

• Pulmonary Disease Physician in Longview, TX
• Providers in Longview, TX by specialty
• Pulmonary Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.