Gershom Jacob Douglas, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5019427 Issued in NC

Practice address

1019 N Lafayette St Ste 1
Shelby, NC 28150-3746

Phone

(704) 487-9766

Fax

(704) 487-9891

NPI assigned

Oct 7, 2021

Last updated

Oct 14, 2026By 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

Medicare fee-for-service enrollment

Enrolled in SC, NC2 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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nephrology Associates of the Carolinas PAGroup PAC ID 1759361223, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

98.51 of 100Reported as group

Quality

91.92

Improvement activities

40

Cost

82.17

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JCJCBA

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.

• Nephrology Associates of the Carolinas, P.a.

  • Nephrology Physician
  • Shelby, NC
  • NPI 1598779803
  Medicare reassignment Care Compare group NPD
• Ear Nose Throat & Audiology Associates

  • Otolaryngology Physician
  • Rock Hill, SC
  • NPI 1366632655
  Medicare reassignment NPD

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791936000000",
    "number": "1902568942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 N LAFAYETTE ST STE 1",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503746",
            "telephone_number": "704-481-7904",
            "fax_number": "704-487-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 N LAFAYETTE ST STE 1",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503746",
            "telephone_number": "704-487-9766",
            "fax_number": "704-487-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "GERSHOM",
        "middle_name": "JACOB",
        "credential": "APNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-07",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5019427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Celena Haaland Ditz
• Divine Health Academy (D&C Home Care Services)
• Andrew Cleveland Dodson
• Robert M Dorn, M.D.
• Douglas C. Huitt D.D.S., P.a.
• Carl Dowdell, LCSW, LCAS
• Courtney Bramlett Dressel, LMFT
• DRS. Johal, Dunning & Associates VIII, PA
• Emily E Drummond
• Lauren Drury, D.P.T.

• Nurse Practitioner in Shelby, NC
• Providers in Shelby, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2026; 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.