Jack Lee Medemar, DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13484 Issued in MI

Practice address

G 4221 Corunna Road
Flint, MI 48532

Phone

(810) 732-8020

Fax

(810) 732-9356

NPI assigned

Mar 30, 2006

Sex

Male

Sole proprietor

No

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 MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hallmark Smiles, PLLC

  • Dental Clinic/Center
  • Flint, MI
  • NPI 1235748187
  NPD (past)

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1003877952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 CORUNNA RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485324316",
            "telephone_number": "810-732-8020",
            "fax_number": "810-732-9356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "G 4221 CORUNNA ROAD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-732-8020",
            "fax_number": "810-732-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEMAR",
        "first_name": "JACK",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Med Tech Rehabilitation Inc
• Med-Scan Inc
• Med-Scan, Inc
• Med-Scan, Inc
• Med-Scan, Inc
• Medex Mid-Michigan LLC
• Medical Coverage Services PC
• Sherrie A Medling, RN
• Medquest Imaging L.L.C
• Arielle Meek

• General Practice Dentistry in Flint, MI
• Providers in Flint, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.

Verify at the official NPI Registry.