Jordan Richard Overstreet

Primary specialty

DentistTaxonomy code 122300000X

License

D011103 Issued in AZ

Practice address

3325 E Huber St
Mesa, AZ 85213-5578

Phone

(480) 444-8749

NPI assigned

Oct 24, 2021

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 TX

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

Practice roles

Locations

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.

• Gila River Health Care Corporation

  dba Komatke Health Center

  • Critical Access Hospital
  • Laveen, AZ
  • NPI 1376538231

  TX

  Medicare reassignment NPD
• Gila River Health Care

  dba Thwajik Ke Outpatient Behavioral Health Services

  • Community/Behavioral Health Agency
  • Laveen, AZ
  • NPI 1598021495
  NPD
• Gila River Health Care Corporation

  dba AK-Chin Clinic

  • Rural Acute Care Hospital
  • Maricopa, AZ
  • NPI 1386633915
  NPD

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

{
    "created_epoch": "1635033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635033600000",
    "number": "1417611716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 E HUBER ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852135578",
            "telephone_number": "480-444-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 E HUBER ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852135578",
            "telephone_number": "480-444-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERSTREET",
        "first_name": "JORDAN",
        "middle_name": "RICHARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-24",
        "last_updated": "2021-10-24",
        "certification_date": "2021-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Otto Bock Patient Care, LLC
• Michone Ouellette, D.C.
• Robert Ouimette, LMSW
• Outreach Health LLC (Outreach Home Care)
• Michael Overman, LMT
• Alexandrea Briand Oviatt, MS LAC
• Andrew M. Owe, DDS
• Cristiana Owen, RD
• Monty Owen, PT
• Steven Douglas Owen, PH.D.

• Dentist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2021; 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.