NPIMap

Individual provider Active NPI

Jeremy Walker, DMD

  • General Practice Dentistry
  • Kuna, ID
National Provider Identifier
1790137073
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-4761 Issued in ID
Practice address
1353 N Meridian Rd
Ste 101
Kuna, ID 83634
Phone
(208) 274-4444
NPI assigned
Jul 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 100836 CA
General Practice Dentistry 1223G0001X D-4761 ID Primary

Addresses

Primary practice location

1353 N Meridian Rd
Ste 101
Kuna, ID 83634

Mailing address

1353 N Meridian Rd
Ste 101
Kuna, ID 83634
Phone (208) 274-4444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
100836CAMDGeneral Practice Dentistry
D-4761IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Deluxe Dental Group Kuna General Practice Past Accepting new patients

Organizations & group practices 1

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1790137073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 N MERIDIAN RD",
            "address_2": "STE 101",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "83634",
            "telephone_number": "208-274-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 N MERIDIAN RD",
            "address_2": "STE 101",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "83634",
            "telephone_number": "208-274-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "100836",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kuna, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.