Kenneth Luke Eades, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12009011A Issued in IN

Practice address

2810 S Walnut Street Pike
Bloomington, IN 47401-8403

Phone

(812) 336-2600

Fax

(812) 336-1090

NPI assigned

Sep 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• K Luke Eades DDS PC

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1962670034
  NPD (past) Authorized official

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376956800000",
    "number": "1235236811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 S WALNUT STREET PIKE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018403",
            "telephone_number": "812-336-2600",
            "fax_number": "812-336-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 S WALNUT STREET PIKE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018403",
            "telephone_number": "812-336-2600",
            "fax_number": "812-336-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EADES",
        "first_name": "KENNETH",
        "middle_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2013-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009011A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha Brooke Duvall
• David A Dwyer, M.D.
• Mary E Dy, OD
• Dycora Transitional Health - Bloomington LLC
• Margaret Mirch Dyer, CPNP
• Katherine Eads
• Samantha Eads, FNP
• Samantha Anne Eads, RN
• Todd A Eads, M.D.
• Eagle Dancer Inc

• Dentist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; 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.

Verify at the official NPI Registry.