Individual provider Active NPI

Ijeoma Grace Juelich, DMD

  • Dentist
  • Union, MO
National Provider Identifier
1285275552
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2019040450 Issued in MO
Practice address
1780 Old Highway 50 E
Union, MO 63084-3397
Phone
(844) 853-8937
NPI assigned
Oct 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2019040450 MO Primary

Addresses

Primary practice location

1780 Old Highway 50 E
Union, MO 63084-3397

Mailing address

1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131

Other names 1

  • Ijeoma Grace Elobuike Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20220316000208 MO Practitioner - Dentist 6002201795 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2019040450MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Health, Inc CurrentSince Jan 1, 2022 Accepting new patients
Compass Health, Inc CurrentSince Jan 1, 2022 Accepting new patients

Locations

1800 Community
#B
Clinton, MO 64735

1800 Community
Clinton, MO 64735
Phone (660) 885-8131

704 E Highway 28
Owensville, MO 65066
Phone (573) 437-2959

102 Compass Point Dr
Saint Charles, MO 63301
Phone (636) 332-8318

2645 Muegge Rd
Saint Charles, MO 63303
Phone (636) 939-6868

101 Progress Pkwy
Sullivan, MO 63080
Phone (573) 468-3555

91 Troy Sq
Troy, MO 63379

1780 Old Highway 50 E
Union, MO 63084
Phone (636) 582-8100

1780 Old Highway 50 E
Ste 111
Union, MO 63084
Phone (636) 584-0305

1780 Old Highway 50 E
Ste 102
Union, MO 63084
Phone (636) 583-1611

616 Burkarth Rd
Warrensburg, MO 64093
Phone (660) 747-7127

19515 Brune Pkwy
Warrenton, MO 63383
Phone (636) 235-4049

1030 Wolfrum Rd
Weldon Spring, MO 63304
Phone (314) 339-7732

1032 Crosswinds Ct
Wentzville, MO 63385
Phone (636) 332-6000

Organizations & group practices 2

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": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1285275552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 OLD HIGHWAY 50 E",
            "city": "UNION",
            "state": "MO",
            "postal_code": "630843397",
            "telephone_number": "844-853-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUELICH",
        "first_name": "IJEOMA",
        "middle_name": "GRACE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-08",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2019040450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IJEOMA",
            "last_name": "ELOBUIKE",
            "middle_name": "GRACE",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Union, MO

Sources for this page

Verify at the official NPI Registry.