Active NPI
Chase Thomas Gundersen, DMD
- Student in an Organized Health Care Education/Training Program
- Indianapolis, IN
National Provider Identifier
1114854858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 12014966A
- Practice address
- 550 University Blvd Ste 3145
Indianapolis, IN 46202-5149 - Phone
- (317) 274-5315
- NPI assigned
- May 6, 2026
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 12014966A | IN | Primary |
Addresses
Primary practice location
550 University Blvd Ste 3145
Indianapolis, IN 46202-5149
Mailing address
868 W 4230 N
Pleasant Grove, UT 84062-8737
Phone (801) 458-8226
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260627000305 | IN | Order and Referring Only - Oral Surgery | 5092288373 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014966A | IN | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778025600000",
"number": "1114854858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "868 W 4230 N",
"city": "PLEASANT GROVE",
"state": "UT",
"postal_code": "840628737",
"telephone_number": "801-458-8226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 UNIVERSITY BLVD STE 3145",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025149",
"telephone_number": "317-274-5315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSEN",
"first_name": "CHASE",
"middle_name": "THOMAS",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-06",
"last_updated": "2026-05-06",
"certification_date": "2026-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IN",
"license": "12014966A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.