Gary Robert Jernberg, D.D.S., M.S.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

8671 Issued in MN

Practice address

99 Navaho Ave
Suite 102
Mankato, MN 56001-4876

Phone

(507) 345-7537

Fax

(507) 345-7538

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Gary R. Jernberg, D.D.S., M.S.D.

  • Periodontics
  • Mankato, MN
  • NPI 1851510952
  NPD (past) Authorized official

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1164420675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE 102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE 102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNBERG",
        "first_name": "GARY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "8671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA MILITARY",
            "identifier": "839878",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "1B005JE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "434218600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah J. Javens Greer, PA-C
• Jennifer Jenniges, MA, LPCC
• Anna Jensen, APRN, CNP
• Annabella Jensen
• Valerie P Jensen, FNP-C
• Christine Jeske, MS, LMFT
• Robert D Jeske, MD
• Jacklynn Paris Jevning
• Lu Ji, M.D.
• Abdi Jibril, MD

• Periodontics in Mankato, MN
• Providers in Mankato, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.