Individual provider Active NPI

Jon Brent Cariker, PMH-NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Springfield, MA
National Provider Identifier
1861915795
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP134530 Issued in TX
Practice address
367 Pine St
Springfield, MA 01105-1930
Phone
(800) 232-0510
Fax
(413) 733-6457
NPI assigned
Jul 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP134530 TX Primary

Addresses

Primary practice location

367 Pine St
Springfield, MA 01105-1930

Mailing address

219 Roma Dr
Lewisville, TX 75067-4191
Phone (817) 647-5455

Other identifiers 1

IdentifierTypeStateIssuer
AP134530OtherTXAPRN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200115002065 VT Practitioner - Nurse Practitioner 1951637024 Reassigns benefits to 1 organization
I20200728003121 CT Practitioner - Nurse Practitioner 1951637024 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP134530TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Natchaug Hospital, Inc. CurrentSince Jun 1, 2020 Accepting new patients
Brattleboro Retreat CurrentSince Dec 2, 2019 Accepting new patients

Locations

189 Storrs Rd
Mansfield Ctr, CT 06250
Phone (860) 456-1311

22 Anna Marsh Ln
Dummerston, VT 05301
Phone (802) 258-3700

1 Anna Marsh Ln
Dummerston, VT 05301

Interoperability endpoints

  • Direct secure messaging: jon.cariker@xdr.hhchealthdirect.org

Organizations & group practices 2

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": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1861915795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 ROMA DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750674191",
            "telephone_number": "817-647-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 PINE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011051930",
            "telephone_number": "800-232-0510",
            "fax_number": "413-733-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARIKER",
        "first_name": "JON",
        "middle_name": "BRENT",
        "credential": "PMH-NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-23",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP134530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE",
            "identifier": "AP134530",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.