Jeannie M Vickery, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

12007392A Issued in IN

Practice address

1121 W Michigan Street
Ds307B
Indianapolis, IN 46202-5186

Phone

(317) 278-3632

Fax

(317) 274-2603

NPI assigned

Nov 4, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

State licenses

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1265769780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN STREET",
            "address_2": "DS307B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025186",
            "telephone_number": "317-278-3632",
            "fax_number": "317-274-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN STREET",
            "address_2": "DS307B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025186",
            "telephone_number": "317-278-3632",
            "fax_number": "317-274-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERY",
        "first_name": "JEANNIE",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IN",
            "license": "12007392A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA DENTAL LICENSE",
            "identifier": "12007392A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Steven Vibbert, D.D.S.
• Vibewell Connect LLC
• Andrew J Vicar, MD
• Amanda Vice
• Madelyn G Vickery-Giddens, NP
• Ryan Vickery, MD
• Vickie Brewer N Vickie Brewer
• Victor Investment Alliance LLC
• Victor Physical Therapy, LLC
• Mitchell T Victor, MD

• Prosthodontics in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Prosthodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; 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.