Jeremy J Youngblood, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

013891 Issued in MO

Practice address

6301 N Oak Trfy
Suite 102
Kansas City, MO 64118-4705

Phone

(816) 453-2323

Fax

(816) 453-3130

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881813392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 N OAK TRFY",
            "address_2": "SUITE 102",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184705",
            "telephone_number": "816-453-2323",
            "fax_number": "816-453-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 N OAK TRFY",
            "address_2": "SUITE 102",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184705",
            "telephone_number": "816-453-2323",
            "fax_number": "816-453-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "JEREMY",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "013891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Young, PHARM.D.
• Sarah R Young
• Spencer Young
• Susan Beth Young
• Thomas William Young, M.D.
• Jo Ann Youngblood, PH.D.
• Clayton Michael Youngers, MD
• Moustafa Younis, MD, MSCR
• Yourmedicinekc.Com LLC
• Yourmedicinekc.Com, L.L.C.

• Periodontics in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Periodontics in Missouri

• 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.
• 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.