Active NPI
Tim J Rieke, DDS
- Dentist
- Jefferson City, MO
National Provider Identifier
1457434722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13681
- Practice address
- 1312 Southwest Blvd
Jefferson City, MO 65109 - Phone
- (573) 634-3115
- Fax
- (573) 634-2381
- NPI assigned
- Oct 23, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 13681 | MO | Primary |
Addresses
Primary practice location
1312 Southwest Blvd
Jefferson City, MO 65109
Mailing address
1312 Southwest Blvd
Jefferson City, MO 65109
Phone (573) 634-3115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13681 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tim Rieke DDS LLC | 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.
-
- General Practice Dentistry
- Jefferson City, MO
- NPI 1295917110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457434722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1312 SOUTHWEST BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "65109",
"telephone_number": "573-634-3115",
"fax_number": "573-634-2381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 SOUTHWEST BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "65109",
"telephone_number": "573-634-3115",
"fax_number": "573-634-2381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEKE",
"first_name": "TIM",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "13681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.