Active NPI
Jeremiah Lance Harris, D.M.D
- Dentist
- Athens, AL
National Provider Identifier
1306045547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5540
- Practice address
- 1005 W Market St
Suite 3
Athens, AL 35611-2454 - Phone
- (256) 232-1404
- Fax
- (256) 230-6738
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 5540 | AL | Primary |
Addresses
Primary practice location
1005 W Market St
Suite 3
Athens, AL 35611-2454
Mailing address
1005 W Market St
Suite 3
Athens, AL 35611-2454
Phone (256) 232-1404
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009912189 | Medicaid | AL | |
| 51543170 | Other | AL | BLUE CROSS BLUE SHIELD AL |
| 1991902 | Other | AL | UCCI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160615001631 | AL | Order and Referring Only - Dentist | 2264723600 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5540 | AL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hawkins McCaghren Partnership | Past | Accepting new patients | |
| Dental Associates of Rogersville, LLC | Dentist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Dentist
- Rogersville, AL
- NPI 1013218486
-
- General Practice Dentistry
- Decatur, AL
- NPI 1265581268
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343088000000",
"number": "1306045547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 W MARKET ST",
"address_2": "SUITE 3",
"city": "ATHENS",
"state": "AL",
"postal_code": "356112454",
"telephone_number": "256-232-1404",
"fax_number": "256-230-6738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 W MARKET ST",
"address_2": "SUITE 3",
"city": "ATHENS",
"state": "AL",
"postal_code": "356112454",
"telephone_number": "256-232-1404",
"fax_number": "256-230-6738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JEREMIAH",
"middle_name": "LANCE",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2012-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "5540",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009912189",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD AL",
"identifier": "51543170",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCCI",
"identifier": "1991902",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, AL
- Matthew D Hanserd, MD
- Maranda Hansley, PMHNP-BC
- Deborah Sue Hargrove, CRNP
- Donna N Harrell
- Harris Dialysis LLC
- Eric Jason Hatfield, D.O.
- Katie Elizabeth Hatfield, CRNP
- Health Care Authority of Athens and Limestone County
- Healthcare Authority of Athens and Limestone County
- Healthcare Authority of Athens and Limestone County
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.