Jeffrey Brennon Childers, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

200500692 Issued in NC

Practice address

3000 Falstaff Rd
Raleigh, NC 27610-1813

Phone

(919) 250-3133

Fax

(919) 250-1176

NPI assigned

Oct 17, 2006

Last updated

Oct 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J.B. Childers, MD, PLLC

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1689057028
  NPD (past) Authorized official
• Community Connections Healthcare Services, LLC

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1073748992
  NPD (past)
• Cottage Health Care Services, Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Raleigh, NC
  • NPI 1487975074
  NPD (past)
• Kidspeace National Centers of North America Inc

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1447395132
  NPD (past)
• Kidspeace National Centers of North America Inc

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1487894200
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1740361013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 COWPER DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082229",
            "telephone_number": "919-368-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 FALSTAFF RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101813",
            "telephone_number": "919-250-3133",
            "fax_number": "919-250-1176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3035 Boone Trail Ext Ste H",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043860",
            "country_code": "US",
            "telephone_number": "910-223-0949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3117 Poplarwood Ct",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276041009",
            "country_code": "US",
            "telephone_number": "919-872-6447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "JEFFREY",
        "middle_name": "BRENNON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "200500692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902475",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Victor Chiavetta, MD
• Caitlin Chicoli
• Joy Ego Chidi, LCASA
• Jackey Chiha
• Child and Family Psychiatry PLLC (Hima Palakurthi)
• Jordan Childers
• Children's Home Society of NC
• Jason Childress
• Latashra Childs
• Mary Elizabeth Childs

• Psychiatry Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.