Derek Ryan Kaelin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN 2003017125 Issued in MO

Practice address

540 W Lasalle St
Springfield, MO 65807-4712

Phone

(417) 887-1220

Fax

(417) 887-0357

NPI assigned

Jan 29, 2007

Last updated

Sep 7, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Derek R. Kaelin D.D.S, LLC

  dba James River Dental

  • Dental Clinic/Center
  • Springfield, MO
  • NPI 1285939157
  Authorized official Same address or phone
• Derek R. Kaelin, D.D.S, LLC

  dba Northside Dental Clinic

  • Dental Clinic/Center
  • Springfield, MO
  • NPI 1295030203
  Authorized official Same address or phone
• Fannin, Kaelin, Ropka, Scott & Sponenberg DDS PC

  dba Parkcrest Dental Group

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1821076811
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1689710873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W. KEARNEY",
            "address_2": "SUITE A",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65803",
            "telephone_number": "417-862-2468",
            "fax_number": "417-863-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 W LASALLE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074712",
            "telephone_number": "417-887-1220",
            "fax_number": "417-887-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAELIN",
        "first_name": "DEREK",
        "middle_name": "RYAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "DEN 2003017125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Kabonic, LCSW
• Michael C Kabonic, D.O.
• Kayla Lee Kaczka, BCBA
• Brooke Kaderly
• Jenna Kadolph
• Teresa Mary Kaelin
• Rebecca A Kahmke, AHCNS
• Robert Leroy Kail, FNP
• Dorothy Darnes Kaiser, LCSW
• Zainab Kakakhel, MD

• General Practice Dentistry in Springfield, MO
• Providers in Springfield, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.

Verify at the official NPI Registry.