Active NPI
Sara Perez
- General Practice Dentistry
- Jeffersonville, IN
National Provider Identifier
1558892885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12013106A
- Practice address
- 4100 Woehrle Rd
Jeffersonville, IN 47130-8396 - Phone
- (812) 280-7500
- NPI assigned
- Mar 27, 2017
- Last updated
- Aug 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 12013106A | IN | Primary |
Addresses
Primary practice location
4100 Woehrle Rd
Jeffersonville, IN 47130-8396
Mailing address
324 E Main St
Unit 404
Louisville, KY 40202-1285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20170802002287 | KY | Order and Referring Only - Dentist | 7810268364 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013106A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627862400000",
"number": "1558892885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 E MAIN ST",
"address_2": "UNIT 404",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 WOEHRLE RD",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471308396",
"telephone_number": "812-280-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "SARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-27",
"last_updated": "2021-08-02",
"certification_date": "2021-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12013106A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; 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.