Myles Sidney Jerdan, MEDICAL DOCTOR

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

30796 Issued in GA

Practice address

1605 Whitesville St
Lagrange, GA 30240-5903

Phone

(877) 231-3376

Fax

(850) 522-8354

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA, TN2 enrollments

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 2

Specialty

Dermatology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists of Georgia LLCGroup PAC ID 5799770624, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar West Georgia Medical Center Hospital, Lagrange, GA, CCN 110016

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Dermatology Specialists of Georgia, LLC

  • Dermatology Physician
  • Athens, GA
  • NPI 1437298957
  Medicare reassignment Care Compare group NPD
• Dermatology Consultants, P.C.

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1851421531
  Medicare reassignment NPD
• Marietta Dermatology Associates PA

  • Dermatology Physician
  • Marietta, GA
  • NPI 1417007212
  Medicare reassignment NPD
• Southeastern Dermatology Group PA

  • Dermatology Physician
  • Panama City, FL
  • NPI 1518972231

  GA

  Medicare reassignment NPD
• North Georgia Dermatopathology PC

  • Clinical Medical Laboratory
  • Marietta, GA
  • NPI 1134217342

  Dermatology

  NPD
• West Georgia Dermatology PC

  • Specialist
  • Lagrange, GA
  • NPI 1760493167
  NPD
• East Tennessee Dermatology Group, PC

  • Dermatology Physician
  • Alcoa, TN
  • NPI 1891050407
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• West Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Lagrange, GA
  • NPI 1821221144
  Care Compare affiliation

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1770549701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 HARRISON AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054464",
            "telephone_number": "850-233-3376",
            "fax_number": "850-522-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 WHITESVILLE ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302405903",
            "telephone_number": "877-231-3376",
            "fax_number": "850-522-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERDAN",
        "first_name": "MYLES",
        "middle_name": "SIDNEY",
        "name_prefix": "Mr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "60136",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "D30796",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "GA",
            "license": "030796",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "30796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q053605",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mykle A Jacobs, D.D.S.
• Richard Harris Jadick, DO
• Hannah Smith James
• Jasmine Naheed, MDPC, LLC
• Deborah Jenkins, LPC
• Alise Nicole Jeter, PHARMD
• Karie Elizabeth Jeter, MD
• Lori S Jeter, P.T.
• JM Group Services Corp
• Rhonda Ann Jobe, LPC

• Dermatology Physician in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.