John D Andersen, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7220 Issued in IA

Practice address

13215 Birch St
Suite 100
Omaha, NE 68164-5431

Phone

(402) 390-0770

NPI assigned

Sep 7, 2006

Last updated

Dec 22, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2013 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198281600000",
    "number": "1306940770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST",
            "address_2": "SUITE 308",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-328-8892",
            "fax_number": "712-328-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13215 BIRCH ST",
            "address_2": "SUITE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681645431",
            "telephone_number": "402-390-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JOHN",
        "middle_name": "D",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "7220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0249052",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Andersen
• Brian Eric Andersen, M.A., LMHP
• Emily Andersen, PA-C
• Haley Andersen
• Janis Kay Andersen
• John Todd Andersen, PHARMD
• Katie E Andersen, DDS
• Kellen Michael Andersen, MD
• Lindy Andersen, PT
• Luke Donald Andersen, PLADC

• Oral and Maxillofacial Surgery (Dentist) in Omaha, NE
• Providers in Omaha, NE by specialty
• Oral and Maxillofacial Surgery (Dentist) in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.