Active NPI
Khristi Rockwood Poidmore, DDS
- Periodontics
- Tucson, AZ
National Provider Identifier
1326282617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D07703
- Practice address
- 3085 W Ina Rd Ste 101
Tucson, AZ 85741-2382 - Phone
- (520) 219-1900
- NPI assigned
- Apr 30, 2009
- Last updated
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6627 | NE | |
| Periodontics | 1223P0300X | 7703 | AZ | |
| Periodontics | 1223P0300X | D07703 | AZ | Primary |
Addresses
Primary practice location
3085 W Ina Rd Ste 101
Tucson, AZ 85741-2382
Mailing address
495 W Highlands View PL
Oro Valley, AZ 85755-1881
Phone (402) 680-8874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20161019003002 | AZ | Order and Referring Only - Other (Physician) | 6103114483 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7703 | AZ | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Valley Endodontics, P.a. | 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.
-
dba Valley Endodontic Specialty Group
- Endodontics
- Phoenix, AZ
- NPI 1659308641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1326282617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "495 W HIGHLANDS VIEW PL",
"city": "ORO VALLEY",
"state": "AZ",
"postal_code": "857551881",
"telephone_number": "402-680-8874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3085 W INA RD STE 101",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857412382",
"telephone_number": "520-219-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POIDMORE",
"first_name": "KHRISTI",
"middle_name": "ROCKWOOD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-30",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NE",
"license": "6627",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "7703",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "D07703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.