Active NPI
Jerry P Gomez, DDS
- General Practice Dentistry
- Nampa, ID
National Provider Identifier
1548374614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D3729
- Practice address
- 223 16TH Ave N
Nampa, ID 83687-4058 - Phone
- (208) 466-0515
- Fax
- (208) 466-5359
- NPI assigned
- Aug 18, 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 | D3729 | ID | Primary |
Addresses
Primary practice location
223 16TH Ave N
Nampa, ID 83687-4058
Mailing address
PO Box 9
Nampa, ID 83653-0009
Phone (208) 466-0515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CS10183 | Other | ID | BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- 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 |
|---|---|---|---|---|
| I20150903002242 | ID | Order and Referring Only - Dentist | 4688980758 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3729 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
| Community Health Clinics, Inc. | General Practice | Past | Accepting new patients |
Interoperability endpoints
- jgomez337631@direct.ochin.org
Organizations & group practices 9
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": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1548374614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "NAMPA",
"state": "ID",
"postal_code": "836530009",
"telephone_number": "208-466-0515",
"fax_number": "208-466-5359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 16TH AVE N",
"city": "NAMPA",
"state": "ID",
"postal_code": "836874058",
"telephone_number": "208-466-0515",
"fax_number": "208-466-5359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "JERRY",
"middle_name": "P",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D3729",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY",
"identifier": "CS10183",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.