Active NPI
Darrel Joe Jenson, DMD
- General Practice Dentistry
- Eugene, OR
National Provider Identifier
1225185440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D5826
- Practice address
- 1814 Coburg Rd
BLDG 2
Eugene, OR 97401-4986 - Phone
- (541) 342-3398
- Fax
- (541) 342-1620
- NPI assigned
- Jan 3, 2007
- Last updated
- Jul 8, 2007
- 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 | D5826 | OR | Primary |
Addresses
Primary practice location
1814 Coburg Rd
BLDG 2
Eugene, OR 97401-4986
Mailing address
1814 Coburg Rd
BLDG 2
Eugene, OR 97401-4986
Phone (541) 342-3398
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22853-6 | Other | OR | OMAP POVIDER NUMBER |
| 829878 | Other | OR | UNITED CONCORDIA POVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20160322000225 | OR | Order and Referring Only - Dentist | 4688971559 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PNW Dental LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225185440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1814 COBURG RD",
"address_2": "BLDG 2",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014986",
"telephone_number": "541-342-3398",
"fax_number": "541-342-1620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 COBURG RD",
"address_2": "BLDG 2",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014986",
"telephone_number": "541-342-3398",
"fax_number": "541-342-1620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSON",
"first_name": "DARREL",
"middle_name": "JOE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D5826",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMAP POVIDER NUMBER",
"identifier": "22853-6",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA POVIDER",
"identifier": "829878",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.