Active NPI
Jonathan Robert Davis
- Psychologist
- Lebanon, PA
National Provider Identifier
1487662813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS04329L
- Practice address
- 200 N 7TH St
Lebanon, PA 17046 - Phone
- (717) 272-1653
- Fax
- (717) 272-4166
- NPI assigned
- Aug 3, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS04329L | PA | Primary |
Addresses
Primary practice location
200 N 7TH St
Lebanon, PA 17046
Mailing address
200 North 7TH Street
Lebanon, PA 17046
Phone (717) 273-1710
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2013 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS04329L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487662813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 NORTH 7TH STREET",
"city": "LEBANON",
"state": "PA",
"postal_code": "17046",
"telephone_number": "717-273-1710",
"fax_number": "717-273-1416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N 7TH ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "17046",
"telephone_number": "717-272-1653",
"fax_number": "717-272-4166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JONATHAN",
"middle_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS04329L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.