Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.
CHARTAVIS JERRY
Complete NPI Record 1841112489
Behavior Technician in Palm Bay, FL
Active since July 27, 2026
Complete NPI Dataset
This page contains the complete raw NPPES record for Chartavis Jerry (NPI 1841112489), an individual behavior technician provider in Palm Bay, FL. All 24 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1841112489 Field 1/24
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/24
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: JERRY Field 3/24
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: CHARTAVIS Field 4/24
- The first name of the provider, if the provider is an individual.
- Provider First Line Business Mailing Address: 2200 MERION DR Field 5/24
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: MELBOURNE Field 6/24
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: FL Field 7/24
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 329355600 Field 8/24
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/24
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 2475 PALM BAY RD NE STE 230 Field 10/24
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: PALM BAY Field 11/24
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: FL Field 12/24
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 329053359 Field 13/24
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 14/24
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3219144055 Field 15/24
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3214738829 Field 16/24
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 19/24
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 106S00000X Field 20/24
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 21/24
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: Y Field 22/24
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 23/24
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
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