Active NPI
Jacob Daniel Meyer
- Dentist
- Blaine, MN
National Provider Identifier
1184355349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14782
- Practice address
- 12904 Central Ave NE
Blaine, MN 55434-4147 - Phone
- (763) 755-1330
- NPI assigned
- Jun 20, 2022
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D14782 | MN | Primary |
Addresses
Primary practice location
12904 Central Ave NE
Blaine, MN 55434-4147
Mailing address
854 104TH LN NE
Blaine, MN 55434-1556
Phone (651) 707-6607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20230104003059 | MN | Order and Referring Only - Dentist | 1658741863 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655683200000",
"number": "1184355349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "854 104TH LN NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554341556",
"telephone_number": "651-707-6607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12904 CENTRAL AVE NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554344147",
"telephone_number": "763-755-1330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYER",
"first_name": "JACOB",
"middle_name": "DANIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-20",
"last_updated": "2022-06-20",
"certification_date": "2022-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.