Jeff Vandeventer, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009154 Issued in IN

Practice address

3105 Middle Road
Suite a
Columbus, IN 47203-4472

Phone

(812) 379-4321

Fax

(812) 379-1977

NPI assigned

Oct 13, 2006

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Locations

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.

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  • NPI 1942977632

  IN

  Medicare reassignment NPD
• Tanner Mitchell DDS LLC

  • Dentist
  • Columbus, IN
  • NPI 1043033293
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1013007491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 MIDDLE ROAD",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034472",
            "telephone_number": "812-379-4321",
            "fax_number": "812-379-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 MIDDLE ROAD",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034472",
            "telephone_number": "812-379-4321",
            "fax_number": "812-379-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVENTER",
        "first_name": "JEFF",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11814",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200450770-A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanarsdall Family Optometry P C
• Kenneth L. Vanarsdall, O.D.
• Jennifer Vanattia, RBT
• Megan Marie Vanderbur, PA
• Sara E Vanderkolk, PA-C
• Lola Marie Vandrey
• Riley Vanosdol, MS, LAT, ATC
• Jyothi P Varanasi, M.D.
• Svetlana Varchenko
• Vascular Partners LLC

• General Practice Dentistry in Columbus, IN
• Providers in Columbus, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.