Bloomington Southside Dental Care. LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLOOMINGTON SOUTHSIDE DENTAL CARE. LLC

Practice address

191 W Gordon Pike
Bloomington, IN 47403-4518

Phone

(812) 824-4444

NPI assigned

Apr 5, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jill Rene Reitmeyer, DDSNPI 1720370059

Title

Owner

Phone

(812) 824-4444

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill Rene Reitmeyer, D.D.S.

  • Dentist
  • Bloomington, IN
  • NPI 1720370059
  NPD Authorized official
• Tiffany Kong, DDS

  • Dentist
  • Bloomington, IN
  • NPI 1386494425
  NPD

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1437890290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 W GORDON PIKE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034518",
            "telephone_number": "812-824-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 W GORDON PIKE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034518",
            "telephone_number": "812-824-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON SOUTHSIDE DENTAL CARE. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "REITMEYER",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-824-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAREY NPI",
            "identifier": "1114439189",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1720370059",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drjillreitmeyer@comcast.net",
            "affiliation": "N",
            "address_1": "191 W Gordon Pike",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474034518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "drjillreitmeyer@comcast.net",
            "affiliation": "N",
            "address_1": "191 W Gordon Pike",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474034518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Providers in Bloomington, IN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.