Active NPI
Jeronimo Jimenez, MSOTR/L
- Occupational Therapist
- Columbia, MD
National Provider Identifier
1497122980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 07336
- Practice address
- 6086 Cedar Wood Dr
Columbia, MD 21044-3675 - Phone
- (443) 766-0298
- NPI assigned
- Aug 31, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 07336 | MD | Primary |
Addresses
Primary practice location
6086 Cedar Wood Dr
Columbia, MD 21044-3675
Mailing address
6086 Cedar Wood Dr
Columbia, MD 21044-3675
Phone (443) 766-0298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07236 | Other | MD | THE MARYLAND STATE BOARD OF OCCUPATIONAL THERAPY PRACTICE |
Other names 1
- Jeronimo Jimenez Gonzalez
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07336 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440979200000",
"number": "1497122980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6086 CEDAR WOOD DR",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443675",
"telephone_number": "443-766-0298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6086 CEDAR WOOD DR",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443675",
"telephone_number": "443-766-0298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "JERONIMO",
"credential": "MSOTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-31",
"last_updated": "2015-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "07336",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE MARYLAND STATE BOARD OF OCCUPATIONAL THERAPY PRACTICE",
"identifier": "07236",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JERONIMO",
"last_name": "JIMENEZ GONZALEZ",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.