Individual provider Active NPI

Jaime Reichlmayr

  • Dentist
  • Ann Arbor, MI
National Provider Identifier
1730560004
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901021943 Issued in MI
Practice address
2365 S Huron Pkwy
Ann Arbor, MI 48104-5156
Phone
(734) 677-8700
Fax
(734) 839-4137
NPI assigned
Jun 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901021943 MI Primary

Addresses

Primary practice location

2365 S Huron Pkwy
Ann Arbor, MI 48104-5156

Mailing address

1795 W Stadium Blvd
Ann Arbor, MI 48103-5290
Phone (734) 677-8700

Other practice location 1

1795 W Stadium Blvd
Ann Arbor, MI 48103-5290
Phone (734) 662-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20160810001531 MI Order and Referring Only - DentistPractitioner - Dentist 9931493178

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Marzonie Gray & Associates PLLC Dentist CurrentSince May 16, 2021 Accepting new patients
Ann Arbor Smiles Haddock PLLC Dentist CurrentSince Aug 7, 2022 Accepting new patients
Apnea Alternatives Dentist PastSince May 16, 2021 Accepting new patients

Locations

2365 S Huron Pkwy
Ann Arbor, MI 48104
Phone (734) 677-1810

2900 Golfside Dr
Ste 6
Ann Arbor, MI 48108
Phone (734) 224-9121

1795 W Stadium Blvd
Ann Arbor, MI 48103
Phone (734) 662-3222

Organizations & group practices 3

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": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1730560004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035290",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 S HURON PKWY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045156",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1795 W Stadium Blvd",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481035290",
            "country_code": "US",
            "telephone_number": "734-662-3222",
            "fax_number": "734-839-4137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REICHLMAYR",
        "first_name": "JAIME",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-12",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.