Individual provider Active NPI

Jeff Michael Zimmerman, DDS

  • General Practice Dentistry
  • Pass Christian, MS
National Provider Identifier
1871732586
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3437-07 Issued in MS
Practice address
13165 Vidalia Rd
Pass Christian, MS 39571-9162
Phone
(228) 255-4355
Fax
(228) 255-6761
NPI assigned
Feb 19, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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 3437-07 MS Primary
General Practice Dentistry 1223G0001X 5936 LA

Addresses

Primary practice location

13165 Vidalia Rd
Pass Christian, MS 39571-9162

Mailing address

13165 Vidalia Rd
Pass Christian, MS 39571-9162
Phone (228) 255-4355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20150716000960 MS Order and Referring Only - DentistPractitioner - Dentist 9537472881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5936LAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Zimmerman Family Dentistry Acquisition, PLLC Current Accepting new patients
Zimmerman Family Dental Dentistry Acquisition Pass Christian PLLC Current Accepting new patients
Charles G. Wood D.M.D.P.a. General Practice Past Accepting new patients

Locations

1213 Broad Ave
Ste 1
Gulfport, MS 39501
Phone (228) 863-5171

13165 Vidalia Rd
Pass Christian, MS 39571
Phone (228) 255-4355

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1871732586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13165 VIDALIA RD",
            "city": "PASS CHRISTIAN",
            "state": "MS",
            "postal_code": "395719162",
            "telephone_number": "228-255-4355",
            "fax_number": "228-255-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13165 VIDALIA RD",
            "city": "PASS CHRISTIAN",
            "state": "MS",
            "postal_code": "395719162",
            "telephone_number": "228-255-4355",
            "fax_number": "228-255-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "JEFF",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-19",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3437-07",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pass Christian, MS

Sources for this page

Verify at the official NPI Registry.