Individual provider Active NPI

Jayne Cernohous, DDS

  • General Practice Dentistry
  • Coon Rapids, MN
National Provider Identifier
1902884760
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10614 Issued in MN
Practice address
8960 Springbrook Dr NW
Suite 150
Coon Rapids, MN 55433-5852
Phone
(763) 784-7993
Fax
(763) 785-8960
NPI assigned
Jan 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D10614 MN Primary

Addresses

Primary practice location

8960 Springbrook Dr NW
Suite 150
Coon Rapids, MN 55433-5852

Mailing address

8960 Springbrook Dr NW
Suite 150
Coon Rapids, MN 55433-5852
Phone (763) 784-7993

Other identifiers 1

IdentifierTypeStateIssuer
067824400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20170913001531 MN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4284532573

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D10614MNMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1902884760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8960 SPRINGBROOK DR NW",
            "address_2": "SUITE 150",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335852",
            "telephone_number": "763-784-7993",
            "fax_number": "763-785-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8960 SPRINGBROOK DR NW",
            "address_2": "SUITE 150",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335852",
            "telephone_number": "763-784-7993",
            "fax_number": "763-785-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERNOHOUS",
        "first_name": "JAYNE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067824400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.