Individual provider Active NPI

James M. Humphrey, DDS, MSD

  • Periodontics
  • Terre Haute, IN
National Provider Identifier
1023267770
Registry record updated Feb 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
12009022A Issued in IN
Practice address
221 S. 19TH Street
Terre Haute, IN 47807-4129
Phone
(812) 232-0064
Fax
(812) 232-3834
NPI assigned
Sep 17, 2008
Last updated
Feb 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 12009022A IN Primary

Addresses

Primary practice location

221 S. 19TH Street
Terre Haute, IN 47807-4129

Mailing address

221 S. 19TH Street
Terre Haute, IN 47807-4129
Phone (812) 232-0064

Other practice location 1

1121 W Michigan St
Indianapolis, IN 46202-5211
Phone (317) 274-7433

Other identifiers 1

IdentifierTypeStateIssuer
100252020AMedicaidIN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160711000904 IN Order and Referring Only - DentistPractitioner - Dentist 3173650918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12009022AINMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Terre Haute Periodontics Periodontics Past Accepting new patients
Terre Haute Endodontics PC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1023267770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 S. 19TH STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478074129",
            "telephone_number": "812-232-0064",
            "fax_number": "812-232-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 S. 19TH STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478074129",
            "telephone_number": "812-232-0064",
            "fax_number": "812-232-3834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 W Michigan St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025211",
            "country_code": "US",
            "telephone_number": "317-274-7433",
            "fax_number": "317-274-2603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "JAMES",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12009022A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100252020A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.