Active NPI
Kody James Crook, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1114651460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11634
- Practice address
- 5071 NE 122ND Ave
Portland, OR 97230-1003 - Phone
- (503) 255-5700
- NPI assigned
- Jul 13, 2022
- Last updated
- Jul 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D11634 | OR | Primary |
Addresses
Primary practice location
5071 NE 122ND Ave
Portland, OR 97230-1003
Mailing address
5809 SE 29TH Ter
Gresham, OR 97080-8608
Other practice location 1
36840 Industrial Way
Sandy, OR 97055-9254
Phone (503) 668-1300
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | PRManager@crdsmiles.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11634 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baseline Dental LLC | Past | Accepting new patients |
Interoperability endpoints
- prmanager@crdsmiles.com
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": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1114651460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5809 SE 29TH TER",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970808608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5071 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301003",
"telephone_number": "503-255-5700"
}
],
"practiceLocations": [
{
"address_1": "36840 Industrial Way",
"address_purpose": "LOCATION",
"city": "Sandy",
"state": "OR",
"postal_code": "970559254",
"country_code": "US",
"telephone_number": "503-668-1300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CROOK",
"first_name": "KODY",
"middle_name": "JAMES",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-13",
"last_updated": "2022-07-13",
"certification_date": "2022-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D11634",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "PRManager@crdsmiles.com",
"affiliation": "N",
"address_1": "5071 NE 122nd Ave",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972301003",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.