Active NPI
Jason Scott Sobkowski, D.M.D.
- Dentist
- Gallup, NM
National Provider Identifier
1982851531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019026207
- Practice address
- 516 E Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- NPI assigned
- Aug 26, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019026207 | IL | Primary |
| Dentist | 122300000X | 2007026095 | MO |
Addresses
Primary practice location
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
3706 Chaco Dr
Gallup, NM 87301-4555
Phone (618) 977-1140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160121001625 | TX | Order and Referring Only - Oral Surgery | 8820156805 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007026095 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383004800000",
"number": "1982851531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3706 CHACO DR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873014555",
"telephone_number": "618-977-1140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 E NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015748",
"telephone_number": "505-722-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBKOWSKI",
"first_name": "JASON",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-26",
"last_updated": "2013-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019026207",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2007026095",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; 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.