Active NPI
Jerry Lester Callaway, MD
- Internal Medicine Physician
- San Jose, CA
National Provider Identifier
1780788356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A25401
- Practice address
- 2512 Samaritan Court
Suite M
San Jose, CA 95124 - Phone
- (408) 358-3715
- Fax
- (408) 356-9189
- NPI assigned
- Sep 12, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A25401 | CA | Primary |
Addresses
Primary practice location
2512 Samaritan Court
Suite M
San Jose, CA 95124
Mailing address
2512 Samaritan Court
Suite M
San Jose, CA 95124
Phone (408) 358-3715
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A254010 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25401 | CA | MD | General Practice Dentistry |
| A25401 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780788356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2512 SAMARITAN COURT",
"address_2": "SUITE M",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95124",
"telephone_number": "408-358-3715",
"fax_number": "408-356-9189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2512 SAMARITAN COURT",
"address_2": "SUITE M",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95124",
"telephone_number": "408-358-3715",
"fax_number": "408-356-9189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAWAY",
"first_name": "JERRY",
"middle_name": "LESTER",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A25401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A254010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.