Individual provider Active NPI

Jorge Rodriquez Jorda, DDS

  • General Practice Dentistry
  • Schererville, IN
National Provider Identifier
1083035976
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12012883A Issued in IN
Practice address
1519 US Highway 41 Ste B8
Schererville, IN 46375-1373
Phone
(786) 838-3683
NPI assigned
Dec 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019030606 IL
General Practice Dentistry 1223G0001X 12012883A IN Primary

Addresses

Primary practice location

1519 US Highway 41 Ste B8
Schererville, IN 46375-1373

Mailing address

1519 US Highway 41 Ste B8
Schererville, IN 46375-1373
Phone (219) 319-0108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20160513001673 IL Order and Referring Only - DentistPractitioner - Dentist 3274822267

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019030606ILMDDentist
12012883AINMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Smile Concepts LLC CurrentSince Mar 20, 2025 Accepting new patients

Locations

1519 US Highway 41
Ste B8
Schererville, IN 46375
Phone (219) 319-0108

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1083035976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 US HIGHWAY 41 STE B8",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751373",
            "telephone_number": "219-319-0108",
            "fax_number": "219-319-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 US HIGHWAY 41 STE B8",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751373",
            "telephone_number": "786-838-3683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIQUEZ JORDA",
        "first_name": "JORGE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-19",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030606",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012883A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schererville, IN

Sources for this page

Verify at the official NPI Registry.