Active NPI
Jose L Ibarrola, D.D.S., M.S.
- Endodontics
- Omaha, NE
National Provider Identifier
1639242332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 5780
- Practice address
- 8909 Grant St
Omaha, NE 68134-6161 - Phone
- (402) 572-1120
- Fax
- (402) 572-9059
- NPI assigned
- Nov 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 5780 | NE | Primary |
Addresses
Primary practice location
8909 Grant St
Omaha, NE 68134-6161
Mailing address
8909 Grant St
Omaha, NE 68134-6161
Phone (402) 572-1120
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04832 | Other | NE | BLUECROSS BLUESHIELD ID |
| 617646 | Other | NE | UNITED CONCORDIA ID |
| 5780 | Other | NE | DELTA DENTAL ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- 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 |
|---|---|---|---|---|
| I20160804001748 | NE | Order and Referring Only - Dentist | 2567756190 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5780 | NE | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas a Jordan DDS LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639242332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8909 GRANT ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681346161",
"telephone_number": "402-572-1120",
"fax_number": "402-572-9059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8909 GRANT ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681346161",
"telephone_number": "402-572-1120",
"fax_number": "402-572-9059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBARROLA",
"first_name": "JOSE",
"middle_name": "L",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NE",
"license": "5780",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD ID",
"identifier": "04832",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID",
"identifier": "617646",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL ID",
"identifier": "5780",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
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.