Active NPI
Ryan E Kloboves
- Dentist
- Indianapolis, IN
National Provider Identifier
1881747640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12010746B
- Practice address
- 5457 West 38TH Street
Indianapolis, IN 46254 - Phone
- (317) 291-9000
- NPI assigned
- Jan 18, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 12010746B | IN | Primary |
Addresses
Primary practice location
5457 West 38TH Street
Indianapolis, IN 46254
Mailing address
12073 Flagstone Drive
Fishers, IN 46037
Phone (317) 578-0085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200522010 | Medicaid | IN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 12010746B | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Immediadent of Indiana, P.C. | Dentist | 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, 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": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881747640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12073 FLAGSTONE DRIVE",
"city": "FISHERS",
"state": "IN",
"postal_code": "46037",
"telephone_number": "317-578-0085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5457 WEST 38TH STREET",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46254",
"telephone_number": "317-291-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOBOVES",
"first_name": "RYAN",
"middle_name": "E",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12010746B",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200522010",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.