Active NPI
Judson Rudolph Wynkoop, D.D.S.
- Dentist
- Columbus, OH
National Provider Identifier
1760524300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30-01-7000
- Practice address
- 1583 E Livingston Ave
Columbus, OH 43205-2930 - Phone
- (614) 252-0936
- NPI assigned
- Feb 12, 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 | 30-01-7000 | OH | Primary |
Addresses
Primary practice location
1583 E Livingston Ave
Columbus, OH 43205-2930
Mailing address
1583E Livingston Ave
Columbus, OH 43205-2930
Phone (614) 252-0936
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0533266 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151231000932 | OH | Order and Referring Only - Other (Non-Physician) | 8325340748 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450742400000",
"number": "1760524300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1583E LIVINGSTON AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432052930",
"telephone_number": "614-252-0936",
"fax_number": "614-252-7260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1583 E LIVINGSTON AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432052930",
"telephone_number": "614-252-0936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNKOOP",
"first_name": "JUDSON",
"middle_name": "RUDOLPH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2015-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30-01-7000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0533266",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2015; 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.