James Edward Vandewater, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

015342 Issued in MO

Practice address

164 Clarkson Executive Park
Ellisville, MO 63011

Phone

(636) 394-7330

Fax

(363) 394-7908

NPI assigned

Aug 22, 2006

Last updated

Feb 23, 2016By 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 2

Addresses

Other names 1

• Jay Vandewater Other name

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

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1689780736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 CLARKSON EXECUTIVE PARK",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112114",
            "telephone_number": "636-394-7330",
            "fax_number": "636-394-7908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 CLARKSON EXECUTIVE PARK",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-394-7330",
            "fax_number": "363-394-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEWATER",
        "first_name": "JAMES",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "015342",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "VANDEWATER",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Susan Diane Trimble, LPTA
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• US Surgical Partners LLC
• US Surgical Partners, LLC
• Usrc Ellisville LLC (U.S. Renal Care Ellisville Dialysis)
• Camryn Vanhooser
• James Wachter, O.D.
• Walgreen Co (Walgreens #04701)
• Walgreen Co (Walgreens #11744)
• Douglas Allen Walker, PT

• Dentist in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.