Individual provider Active NPI

Scott Bryan Clemons, D.D.S.

  • General Practice Dentistry
  • Iowa City, IA
National Provider Identifier
1356478275
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7640 Issued in IA
Practice address
1950 Lower Muscatine Rd
Iowa City, IA 52240-3108
Phone
(319) 337-6226
Fax
(319) 354-9650
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7640 IA Primary

Addresses

Primary practice location

1950 Lower Muscatine Rd
Iowa City, IA 52240-3108

Mailing address

1590 Lower Muscatine Rd
Iowa City, IA 52240
Phone (319) 337-6226

Other identifiers 2

IdentifierTypeStateIssuer
0115162MedicaidIA
1437247202OtherIANPI FOR CORPORATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20160511000495 IA Order and Referring Only - DentistPractitioner - Dentist 6204125487

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7640IAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Applewhite Dental Iowa PC General Practice 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1356478275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 LOWER MUSCATINE RD",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "52240",
            "telephone_number": "319-337-6226",
            "fax_number": "319-354-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 LOWER MUSCATINE RD",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522403108",
            "telephone_number": "319-337-6226",
            "fax_number": "319-354-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "SCOTT",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "7640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115162",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR CORPORATION",
            "identifier": "1437247202",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.