Daniel Grant Freeman Jefferies, DMD
Individual provider Active NPI Dentist · Ponderay, ID
NPI 1285293167 · NPPES record last updated Jun 13, 2019
Key facts
- NPI
- 1285293167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D-5050 (ID)
- Practice address
- 30410 Highway 200
Ponderay, ID 83852-9601 - Phone
- (208) 263-7101
- NPI assigned
- Jun 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200220000687 | ID | Order and Referring Only - Dentist |
0840627436 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boundary Regional Community Health Center, Inc. | Past | Accepting new patients | |
| Boundary Regional Community Health Center Inc | Past | Accepting new patients |
Interoperability endpoints
- daniel.jefferies.p1@direct.kch.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D-5050 | ID | Yes |
Addresses
Primary practice location
30410 Highway 200
Ponderay, ID 83852-9601
Mailing address
514 Jenny LN
Sandpoint, ID 83864-6006
Phone (801) 953-7560
Other providers in Ponderay, ID
- Idaho Dept of Health & Welfare Reg 1 Ahm PSR Sandpoint
- Idaho Dept of Health & Welfare Reg 1 Amh Clinic Sandpoint
- Inland Northwest Renal Care Group, LLC
- Innovative Anesthesia
- Inspire Change Therapeutic Services PLLC
- Brenda Kay Jerald
- Jesstherapy PLLC
- Kauai in-Home Therapy LLC
- Kids in Motion Physical Therapy, PC
- Knopp Anesthesia Services LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.