Individual provider Active NPI

Gerald Vincy Cross, D.D.S.

  • General Practice Dentistry
  • Ardmore, OK
National Provider Identifier
1215976246
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4448 Issued in OK
Practice address
800 12TH Ave NW
Ardmore, OK 73401-5708
Phone
(580) 226-6092
Fax
(580) 226-8791
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4448 OK Primary

Addresses

Primary practice location

800 12TH Ave NW
Ardmore, OK 73401-5708

Mailing address

800 12TH Ave NW
Ardmore, OK 73401-5708
Phone (580) 226-6092

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160219000299 OK Order and Referring Only - DentistPractitioner - Dentist 8527207695

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4448OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gerald Vincy Cross, D.D.S., Mba, Inc. General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215976246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015708",
            "telephone_number": "580-226-6092",
            "fax_number": "580-226-8791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015708",
            "telephone_number": "580-226-6092",
            "fax_number": "580-226-8791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROSS",
        "first_name": "GERALD",
        "middle_name": "VINCY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.