Active NPI
James C Walgren, DDS
- General Practice Dentistry
- Dubuque, IA
National Provider Identifier
1164522579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 06360
- Practice address
- 1122 Rockdale Rd
Dubuque, IA 52003-7285 - Phone
- (556) 556-2650
- Fax
- (563) 556-2331
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 06360 | IA | Primary |
Addresses
Primary practice location
1122 Rockdale Rd
Dubuque, IA 52003-7285
Mailing address
1122 Rockdale Rd
Dubuque, IA 52003
Phone (556) 556-2650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0150763 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- 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 |
|---|---|---|---|---|
| I20160505001967 | IA | Order and Referring Only - Oral Surgery | 5395044721 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06360 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445904000000",
"number": "1164522579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 ROCKDALE RD",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "52003",
"telephone_number": "556-556-2650",
"fax_number": "563-556-2331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 ROCKDALE RD",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520037285",
"telephone_number": "556-556-2650",
"fax_number": "563-556-2331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALGREN",
"first_name": "JAMES",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2015-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "06360",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0150763",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dubuque, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.