Individual provider Active NPI

Gerald Warrell, D.D.S.

  • General Practice Dentistry
  • South Bend, IN
National Provider Identifier
1508020066
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12008047A Issued in IN
Practice address
2314 Miami St
South Bend, IN 46614-1336
Phone
(574) 288-9233
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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 12008047A IN Primary

Addresses

Primary practice location

2314 Miami St
South Bend, IN 46614-1336

Mailing address

2314 Miami St
South Bend, IN 46614-1336
Phone (574) 288-9233

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
I20161109001302 IN Order and Referring Only - DentistPractitioner - Dentist 2062791387

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1508020066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 MIAMI ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466141336",
            "telephone_number": "574-288-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 MIAMI ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466141336",
            "telephone_number": "574-288-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARRELL",
        "first_name": "GERALD",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008047A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.