Active NPI
Yousef Odeh Jefferson, DDS
- Dentist
- Memphis, TN
National Provider Identifier
1003378779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22569
- Practice address
- 2953 Broad Ave
Memphis, TN 38112-2957 - Phone
- (901) 842-3171
- NPI assigned
- Apr 2, 2019
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 22569 | TX | Primary |
Addresses
Primary practice location
2953 Broad Ave
Memphis, TN 38112-2957
Mailing address
3461 Mainer St
Houston, TX 77021-5533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Medicaid | TN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | NA | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190917002889 | TN | Order and Referring Only - Dentist | 9234468224 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22569 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554163200000",
"number": "1003378779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3461 MAINER ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770215533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2953 BROAD AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381122957",
"telephone_number": "901-842-3171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "YOUSEF",
"middle_name": "ODEH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-02",
"last_updated": "2019-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "22569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NONE",
"state": "TN"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "NA",
"affiliation": "N",
"endpointDescription": "NA",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "NA",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "NA",
"address_1": "2953 Broad Ave",
"city": "Memphis",
"state": "TN",
"country_code": "US",
"postal_code": "381122957",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.