Active NPI
James Walter Hodge, D.D.S.
- General Practice Dentistry
- Ketchum, ID
National Provider Identifier
1942587340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D-2023
- Practice address
- 620 1St Avenue North
Ketchum, ID 83340-2273 - Phone
- (208) 726-2233
- NPI assigned
- Nov 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-2023 | ID | Primary |
Addresses
Primary practice location
620 1St Avenue North
Ketchum, ID 83340-2273
Mailing address
PO Box 2273
Ketchum, ID 83340-2273
Phone (208) 726-2233
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 |
|---|---|---|---|
| D-2023 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1942587340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2273",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833402273",
"telephone_number": "208-726-2233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 1ST AVENUE NORTH",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833402273",
"telephone_number": "208-726-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGE",
"first_name": "JAMES",
"middle_name": "WALTER",
"name_prefix": "Mr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-14",
"last_updated": "2011-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D-2023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.