Active NPI
Jim Dylan Davis, CAPRC, CPSP
- Peer Specialist
- Lafayette, IN
National Provider Identifier
1679361893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 914 South St
Lafayette, IN 47901-1416 - Phone
- (765) 742-1088
- NPI assigned
- Apr 28, 2025
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | IN | Primary |
Addresses
Primary practice location
914 South St
Lafayette, IN 47901-1416
Mailing address
531 Duroc CT Apt a
Lafayette, IN 47909-6779
Phone (812) 508-2980
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745798400000",
"number": "1679361893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "531 DUROC CT APT A",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479096779",
"telephone_number": "812-508-2980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 SOUTH ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479011416",
"telephone_number": "765-742-1088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JIM",
"middle_name": "DYLAN",
"credential": "CAPRC, CPSP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-28",
"last_updated": "2025-04-28",
"certification_date": "2025-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "IN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.