Active NPI
Jason Otto Gambrel, D.M.D.
- Dentist
- Richmond, KY
National Provider Identifier
1306825732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7992
- Practice address
- 1018 Ival James Blvd
Suite C
Richmond, KY 40475-8026 - Phone
- (859) 626-9851
- Fax
- (859) 626-9854
- NPI assigned
- Jan 13, 2006
- Last updated
- Jun 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7992 | KY | Primary |
| General Practice Dentistry | 1223G0001X | 7992 | KY |
Addresses
Primary practice location
1018 Ival James Blvd
Suite C
Richmond, KY 40475-8026
Mailing address
1018 Ival James Blvd
Suite C
Richmond, KY 40475-8026
Phone (859) 626-9851
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60004066 | Medicaid | KY | |
| 45004025 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7992 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason O Gambrel P.S.C. | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1306825732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1018 IVAL JAMES BLVD",
"address_2": "SUITE C",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404758026",
"telephone_number": "859-626-9851",
"fax_number": "859-626-9854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1018 IVAL JAMES BLVD",
"address_2": "SUITE C",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404758026",
"telephone_number": "859-626-9851",
"fax_number": "859-626-9854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBREL",
"first_name": "JASON",
"middle_name": "OTTO",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-13",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "7992",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "7992",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60004066",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45004025",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.