Active NPI
Jerry S Anderson
- Hearing Instrument Specialist
- Fort Myers, FL
National Provider Identifier
1790077121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- HA7505
- Practice address
- 12381 S Cleveland Ave Ste 405
Fort Myers, FL 33907-3893 - Phone
- (239) 461-9321
- Fax
- (239) 461-5354
- NPI assigned
- May 4, 2011
- 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 |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | HA7505 | CA | Primary |
Addresses
Primary practice location
12381 S Cleveland Ave Ste 405
Fort Myers, FL 33907-3893
Mailing address
750 N Commons Dr Ste 200
Aurora, IL 60504-7940
Phone (630) 303-5380
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HA7505 | CA | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connect Hearing Inc | Hearing Instrument Specialist | Past | Accepting new patients |
Organizations & group practices 1
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": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661817600000",
"number": "1790077121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 N COMMONS DR STE 200",
"city": "AURORA",
"state": "IL",
"postal_code": "605047940",
"telephone_number": "630-303-5380",
"fax_number": "630-303-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12381 S CLEVELAND AVE STE 405",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339073893",
"telephone_number": "239-461-9321",
"fax_number": "239-461-5354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JERRY",
"middle_name": "S",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-04",
"last_updated": "2022-08-30",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "CA",
"license": "HA7505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.