Jillian Alexandra Wallen, B.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

LL539 Issued in MD

Practice address

444 So. 44TH Street
Unmc Pediatric Dentistry
Omaha, NE 68198-5450

Phone

(402) 559-7954

Fax

(402) 559-9307

NPI assigned

Apr 22, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jillian Alexandra Easton Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jillian.wallen.p1@direct.charlesdrew.nextgenshare.com

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.

• Charles Drew Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1255302170
  Medicare reassignment NPD
• Charles Drew Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1215767421
  NPD
• Charles Drew Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1386218212
  NPD (past)

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1750555793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 SO. 44TH STREET",
            "address_2": "UNMC PEDIATRIC DENTISTRY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681985450",
            "telephone_number": "402-559-7954",
            "fax_number": "402-559-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 SO. 44TH STREET",
            "address_2": "UNMC PEDIATRIC DENTISTRY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681985450",
            "telephone_number": "402-559-7954",
            "fax_number": "402-559-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "JILLIAN",
        "middle_name": "ALEXANDRA",
        "credential": "B.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-22",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "LL539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "EASTON",
            "middle_name": "ALEXANDRA",
            "credential": "B.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan H Wallace, APRN
• Tiffany Wallace, CNA, CMA, MS
• Zarria Wallace
• Joy J Wallar, MHP
• Ashley Brooke Wallen, PA-C
• Cierra Waller
• Hannah Waller, MS CCC SLP
• Alexandra Anne Wallgren, MS, CGC
• Warren Leonard Wallin, PHARMACIST
• Sidney Walling

• Pediatric Dentistry in Omaha, NE
• Providers in Omaha, NE by specialty
• Pediatric Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.