Individual provider Active NPI

John Matthew Cronkhite, DDS

  • General Practice Dentistry
  • Lafayette, IN
National Provider Identifier
1902924673
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010734A Issued in IN
Practice address
3667 Braddock Dr
Suite B
Lafayette, IN 47909-7337
Phone
(765) 471-6025
Fax
(765) 471-6028
NPI assigned
Mar 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 12010734A IN Primary

Addresses

Primary practice location

3667 Braddock Dr
Suite B
Lafayette, IN 47909-7337

Mailing address

4998 Wendys Way
Bloomington, IN 47403-8813
Phone (812) 322-6580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625001116 IN Order and Referring Only - Other (Non-Physician) 0648581058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12010734AINMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
J Matthew Cronkhite DDS PC Past Accepting new patients
Transitions Dental Company General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902924673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4998 WENDYS WAY",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474038813",
            "telephone_number": "812-322-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3667 BRADDOCK DR",
            "address_2": "SUITE B",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479097337",
            "telephone_number": "765-471-6025",
            "fax_number": "765-471-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRONKHITE",
        "first_name": "JOHN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010734A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.