Active NPI
Jason John Jerisha, DPM
- Podiatrist
- Deerfield, IL
National Provider Identifier
1467402388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 36-003416
- Practice address
- 775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342 - Phone
- (800) 317-0711
- Fax
- (800) 434-7113
- NPI assigned
- May 11, 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 36-003416 | OH | Primary |
Addresses
Primary practice location
775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342
Mailing address
232 Arbors Pkwy W
Number 22
Findlay, OH 45840-8741
Phone (419) 425-1901
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000543939 | Other | OH | ANTHEM BCBS |
| 000000377305 | Other | OH | ANTHEM BCBS |
| 2589819 | Medicaid | OH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36-003416 | OH | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primesource Healthcare Systems, Inc. | Podiatrist | Past | Accepting new patients |
| Primesource Healthcare Systems, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Podiatrist
- Buffalo Grove, IL
- NPI 1497704126
-
- Durable Medical Equipment & Medical Supplies
- Columbus, OH
- NPI 1801008644
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1467402388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 ARBORS PKWY W",
"address_2": "NUMBER 22",
"city": "FINDLAY",
"state": "OH",
"postal_code": "458408741",
"telephone_number": "419-425-1901",
"fax_number": "419-427-2688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 WAUKEGAN RD",
"address_2": "SUITE 200",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154342",
"telephone_number": "800-317-0711",
"fax_number": "800-434-7113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERISHA",
"first_name": "JASON",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "OH",
"license": "36-003416",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000543939",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000377305",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2589819",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deerfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.