Jason Patrick Glock, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6253 Issued in NE

Practice address

357 E 4TH St
Wahoo, NE 68066-1920

Phone

(402) 443-5959

NPI assigned

Jan 2, 2008

Last updated

Jan 2, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

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.

• Wahoo Dental Associates, P.C.

  • General Practice Dentistry
  • Wahoo, NE
  • NPI 1033123336
  NPD (past) Authorized official

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199232000000",
    "number": "1871778423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 E 4TH ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661920",
            "telephone_number": "402-443-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 E 4TH ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661920",
            "telephone_number": "402-443-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLOCK",
        "first_name": "JASON",
        "middle_name": "PATRICK",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-02",
        "last_updated": "2008-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "04786",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025583000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Kaye Fulton, APRN
• Generation Clinical Partners LLC
• Brent Geringer, DC
• Girmal Enterprises LLC (Hospice and Home Healthcare of Saunders County)
• Girmal Enterprises LLC (Hospice and Home Healthcare of Saunders County)
• Monica K Govind
• Michelle Renee Hall, PTA
• Leaha M Hammer
• Morgan Hancock-Stewart, MD
• Thomas G Hart, DDS

• General Practice Dentistry in Wahoo, NE
• Providers in Wahoo, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; 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.