Active NPI
Charles S Gery Jr., PA-C
- Surgical Physician Assistant
- Salem, VA
National Provider Identifier
1962484915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 0110840469
- Practice address
- 1802 Braeburn Dr
Suite 1310
Salem, VA 24153-7357 - Phone
- (540) 776-2020
- Fax
- (540) 776-2017
- NPI assigned
- Nov 16, 2005
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0110840469 | VA | Primary |
Addresses
Primary practice location
1802 Braeburn Dr
Suite 1310
Salem, VA 24153-7357
Mailing address
PO Box 277730
Atlanta, GA 30384-7730
Phone (615) 373-7600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00413631 | Other | MEDICARE RR | |
| 1962484915 | Medicaid | VA | |
| P00453914 | Other | VA | RAILROAD MEDICARE |
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
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardiothoracic Surgeons of Roanoke Valley LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Cardiothoracic Surgeons of Roanoke Valley
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Salem, VA
- NPI 1346343563
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237507200000",
"number": "1962484915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 277730",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303847730",
"telephone_number": "615-373-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 BRAEBURN DR",
"address_2": "SUITE 1310",
"city": "SALEM",
"state": "VA",
"postal_code": "241537357",
"telephone_number": "540-776-2020",
"fax_number": "540-776-2017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERY",
"first_name": "CHARLES",
"middle_name": "S",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2009-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "VA",
"license": "0110840469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "P00413631",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1962484915",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00453914",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.