Active NPI
Robert Young Ferguson Jr., DDS PA
- General Practice Dentistry
- Austin, TX
National Provider Identifier
1528163318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14049
- Practice address
- 10123 Lake Creek Pkwy
BLDG 2
Austin, TX 78729 - Phone
- (512) 250-8101
- Fax
- (512) 258-7154
- NPI assigned
- Sep 14, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14049 | TX | Primary |
Addresses
Primary practice location
10123 Lake Creek Pkwy
BLDG 2
Austin, TX 78729
Mailing address
10123 Lake Creek Pkwy
BLDG 2
Austin, TX 78729
Phone (512) 250-8101
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224002719 | TX | Order and Referring Only - Dentist | 7618272923 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14049 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J. Kip Nielson DDS PLLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528163318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10123 LAKE CREEK PKWY",
"address_2": "BLDG 2",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78729",
"telephone_number": "512-250-8101",
"fax_number": "512-258-7154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10123 LAKE CREEK PKWY",
"address_2": "BLDG 2",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78729",
"telephone_number": "512-250-8101",
"fax_number": "512-258-7154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGUSON",
"first_name": "ROBERT",
"middle_name": "YOUNG",
"name_suffix": "Jr.",
"credential": "DDS PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Austin, TX
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.