MEDICARE: JERRY GATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417824061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY GATES

Provider Business Mailing Address
First Line	:	303 KINSEY RD
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-1410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7042 OLD TROY PIKE
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2747
Country	:	US
Telephone Number	:	937-718-8279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “ JERRY GATES ” Practice Location

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