Jerry Michael Carbone, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D-3642EN Issued in ID

Practice address

12249 W McMillan Rd
Boise, ID 83713-0555

Phone

(208) 917-2855

Fax

(208) 258-7553

NPI assigned

Aug 17, 2006

Last updated

Oct 1, 2014By 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

Medicare fee-for-service enrollment

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Intermountain Dental Specialists

  • Dental Clinic/Center
  • Boise, ID
  • NPI 1134522535
  NPD (past) Authorized official

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412121600000",
    "number": "1316050628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12249 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130555",
            "telephone_number": "208-917-2855",
            "fax_number": "208-258-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12249 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130555",
            "telephone_number": "208-917-2855",
            "fax_number": "208-258-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBONE",
        "first_name": "JERRY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2014-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D-3642EN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Carbajal, PHARMD
• Jose Carbajal
• Julie Carbajal
• Lucia Carbajal, MD
• Kylie Carbol, PHARMD
• Karla Carcas
• Stacey Carda
• Salvador Cardenas Padilla, LCSW
• Cardiac Cin of Boise LLC
• Marcco Cardiel

• Endodontics in Boise, ID
• Providers in Boise, ID by specialty
• Endodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.

Verify at the official NPI Registry.