NPIMap

Individual provider Active NPI

Jerald Joseph Pero, RPH

  • Pharmacist
  • Oconomowoc, WI
National Provider Identifier
1669801148
Registry record updated Nov 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
11766-040 Issued in WI
Practice address
1284 N Summit Ave
Suite 100
Oconomowoc, WI 53066-4459
Phone
(262) 569-8204
Fax
(262) 569-8215
NPI assigned
Nov 5, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 11766-040 WI Primary

Addresses

Primary practice location

1284 N Summit Ave
Suite 100
Oconomowoc, WI 53066-4459

Mailing address

1284 N Summit Ave
Suite 100
Oconomowoc, WI 53066-4459
Phone (262) 569-8204

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
11766-040WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Pharmacy, Inc Past Accepting new patients
Aurora Pharmacy 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.

NPI Registry JSON

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1669801148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1284 N SUMMIT AVE",
            "address_2": "SUITE 100",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664459",
            "telephone_number": "262-569-8204",
            "fax_number": "262-569-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1284 N SUMMIT AVE",
            "address_2": "SUITE 100",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664459",
            "telephone_number": "262-569-8204",
            "fax_number": "262-569-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERO",
        "first_name": "JERALD",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-05",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "11766-040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.