Individual provider Active NPI

James S Jansen

  • General Practice Dentistry
  • Kendallville, IN
National Provider Identifier
1407807738
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007950A Issued in IN
Practice address
230 S Main St
Kendallville, IN 46755-1718
Phone
(260) 347-5115
NPI assigned
May 12, 2006
Last updated
Feb 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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 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

IdentifierTypeStateIssuer
100190860MedicaidIN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150608002874 IN Order and Referring Only - DentistPractitioner - Oral SurgeryPractitioner - Dentist 1153642756

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12007950AINMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Jansen Family Dentistry, P.C. General Practice PastSince Jul 28, 2024 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.

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

Verify at the official NPI Registry.