NPIMap

Individual provider Active NPI

Jason McKerry, MD

  • Pediatrics Physician
  • Tulalip, WA
National Provider Identifier
1407081458
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD 60096572 Issued in WA
Practice address
7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone
(360) 716-4511
Fax
(360) 716-5782
NPI assigned
May 20, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD 60096572 WA Primary

Addresses

Primary practice location

7520 Totem Beach Rd
Tulalip, WA 98271-6160

Mailing address

7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone (360) 716-4511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091209000201 WA Practitioner - Pediatric Medicine 0749329464 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD 60096572WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umbrella Pediatrics PC Pediatrics CurrentSince Dec 1, 2024 Accepting new patients
Tulalip Tribes Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients
Tulalip Tribes Health Clinic Past Accepting new patients
Tulalip Tribes Health Clinic Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients
Tulalip Health Clinic Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients
Tulalip Tribes Health Clinic Past Accepting new patients
Tulalip Tribes Past Accepting new patients
Tulalip Tribes Health Clinic Pediatrics Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients
Tulalip Tribes of Washington Past Accepting new patients

Locations

23511 56th Ave W
Ste 105
Mountlake Terrace, WA 98043
Phone (206) 546-2421

Organizations & group practices 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1407081458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7520 TOTEM BEACH RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982716160",
            "telephone_number": "360-716-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7520 TOTEM BEACH RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982716160",
            "telephone_number": "360-716-4511",
            "fax_number": "360-716-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKERRY",
        "first_name": "JASON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-20",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD 60096572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulalip, WA

Sources for this page

Verify at the official NPI Registry.