Individual provider Active NPI

Jennifer Falk Crumbaugh, D.D.S.

  • Dentist
  • Independence, MO
National Provider Identifier
1093128159
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2014016638 Issued in MO
Practice address
17020 E US Highway 40 Ste 7
Independence, MO 64055-5365
Phone
(816) 350-7710
NPI assigned
Jun 6, 2014
Last updated
Apr 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2014016638 MO Primary

Addresses

Primary practice location

17020 E US Highway 40 Ste 7
Independence, MO 64055-5365

Mailing address

5709 NE Maybrook Rd
Lees Summit, MO 64064-2365
Phone (785) 554-2528

Other names 1

  • Ms. Jennifer Lynne Falk Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20150923000148 MO Order and Referring Only - DentistPractitioner - Dentist 8921315029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2014016638MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Darrell W. Davis, D.D.S., P.C Dentist PastSince Apr 13, 2025 Accepting new patients

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, 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": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1093128159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5709 NE MAYBROOK RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642365",
            "telephone_number": "785-554-2528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17020 E US HIGHWAY 40 STE 7",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640555365",
            "telephone_number": "816-350-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMBAUGH",
        "first_name": "JENNIFER",
        "middle_name": "FALK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-06",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2014016638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "FALK",
            "middle_name": "LYNNE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Independence, MO

Sources for this page

Verify at the official NPI Registry.