NPIMap

Organization Active NPI

Jerry W. Kaalberg, DDS P.C.

  • Periodontics
  • Cedar Rapids, IA
National Provider Identifier
1184737801
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
5773 Issued in IA
Legal business name
JERRY W. KAALBERG, DDS P.C.
Practice address
2727 1St Ave SE
Cedar Rapids, IA 52402-4844
Phone
(319) 364-7111
Fax
(319) 364-1726
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerry W. Kaalberg, DDSNPI 1295902161
Title
President
Phone
(319) 364-7111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 5773 IA Primary

Addresses

Primary practice location

2727 1St Ave SE
Cedar Rapids, IA 52402-4844

Mailing address

2727 1St Ave SE
Cedar Rapids, IA 52402-4844
Phone (319) 364-7111

Other identifiers 1

IdentifierTypeStateIssuer
0060004MedicaidIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184737801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 1ST AVE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524024844",
            "telephone_number": "319-364-7111",
            "fax_number": "319-364-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 1ST AVE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524024844",
            "telephone_number": "319-364-7111",
            "fax_number": "319-364-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY W. KAALBERG, DDS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAALBERG",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-364-7111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IA",
            "license": "5773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060004",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.