Active NPI
James S Jansen
- General Practice Dentistry
- Kendallville, IN
National Provider Identifier
1407807738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12007950A
- Practice address
- 230 S Main St
Kendallville, IN 46755-1718 - Phone
- (260) 347-5115
- NPI assigned
- May 12, 2006
- Last updated
- Feb 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12007950A | IN | Primary |
Addresses
Primary practice location
230 S Main St
Kendallville, IN 46755-1718
Mailing address
230 S Main St
Kendallville, IN 46755-1718
Phone (260) 347-5115
Other practice location 1
2101 E. Coliseum Blvd.
Neff Hall 109
Fort Wayne, IN 46805-1499
Phone (317) 274-7433
Other practice location 2
1121 W Michigan St
Indianapolis, IN 46202-5211
Phone (317) 274-7433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100190860 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20150608002874 | IN | Order and Referring Only - Dentist | 1153642756 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007950A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jansen Family Dentistry, P.C. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Kendallville, IN
- NPI 1952351264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770940800000",
"number": "1407807738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 S MAIN ST",
"city": "KENDALLVILLE",
"state": "IN",
"postal_code": "467551718",
"telephone_number": "260-347-5115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 S MAIN ST",
"city": "KENDALLVILLE",
"state": "IN",
"postal_code": "467551718",
"telephone_number": "260-347-5115"
}
],
"practiceLocations": [
{
"address_1": "2101 E. Coliseum Blvd.",
"address_2": "Neff Hall 109",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468051499",
"country_code": "US",
"telephone_number": "317-274-7433",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1121 W Michigan St",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462025211",
"country_code": "US",
"telephone_number": "317-274-7433",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JANSEN",
"first_name": "JAMES",
"middle_name": "S",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2026-02-13",
"certification_date": "2026-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12007950A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100190860",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kendallville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; 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.