NPIMap

Individual provider Active NPI

Robert W Hendricks, DDS

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1598836694
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3658 Issued in ID
Practice address
317 W Cherry LN
Meridian, ID 83642-1608
Phone
(208) 888-2055
Fax
(208) 895-0583
NPI assigned
Nov 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 D3658 ID Primary

Addresses

Primary practice location

317 W Cherry LN
Meridian, ID 83642-1608

Mailing address

317 W Cherry LN
Meridian, ID 83642-1608
Phone (208) 888-2055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160120002575 ID Order and Referring Only - DentistPractitioner - Dentist 5698078913

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D3658IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew 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

  • Direct secure messaging: rhendricks604932@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": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1598836694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421608",
            "telephone_number": "208-888-2055",
            "fax_number": "208-895-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421608",
            "telephone_number": "208-888-2055",
            "fax_number": "208-895-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "ROBERT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.