Active NPI
Amanda Jorgensen, D.D.S.
- Dentist
- Grimes, IA
National Provider Identifier
1235158452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 08223
- Practice address
- 100 SW Brookside Dr
Grimes, IA 50111 - Phone
- (515) 986-3926
- Fax
- (515) 986-5116
- NPI assigned
- Jul 19, 2006
- Last updated
- Apr 26, 2013
- Sex
- Female
- 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 | 08223 | IA | Primary |
Addresses
Primary practice location
100 SW Brookside Dr
Grimes, IA 50111
Mailing address
1410 SE Rosewood CT
Waukee, IA 50263-8350
Phone (515) 778-4278
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0293605 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08223 | IA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grimes Dental Enterprises, LLC | 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.
-
- General Practice Dentistry
- Grimes, IA
- NPI 1316750425
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366934400000",
"number": "1235158452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1410 SE ROSEWOOD CT",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502638350",
"telephone_number": "515-778-4278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SW BROOKSIDE DR",
"city": "GRIMES",
"state": "IA",
"postal_code": "50111",
"telephone_number": "515-986-3926",
"fax_number": "515-986-5116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "AMANDA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2013-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "08223",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0293605",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grimes, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.