Active NPI
Paul Timmons, DDS
- Dentist
- Kouts, IN
National Provider Identifier
1679645584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12008736
- Practice address
- 306 S Main St
Kouts, IN 46347-0429 - Phone
- (219) 766-3693
- NPI assigned
- Nov 15, 2006
- Last updated
- Jul 9, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12008736 | IN | Primary |
Addresses
Primary practice location
306 S Main St
Kouts, IN 46347-0429
Mailing address
PO Box 429
306 South Main Street
Kouts, IN 46347-0429
Phone (219) 766-3693
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20160222001519 | IN | Order and Referring Only - Dentist | 5496050916 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12008736 | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1679645584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 429",
"address_2": "306 SOUTH MAIN STREET",
"city": "KOUTS",
"state": "IN",
"postal_code": "463470429",
"telephone_number": "219-766-3693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 S MAIN ST",
"city": "KOUTS",
"state": "IN",
"postal_code": "463470429",
"telephone_number": "219-766-3693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMMONS",
"first_name": "PAUL",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12008736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kouts, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.