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DR. TAKANARI MIYAMOTO DDS
NPI 1376730143
Dentist - Periodontics in La Vista, NE

Active since September 26, 2007Opted out of Medicare · through Oct 28, 2026
12110 PORT GRACE BLVD STE 202, LA VISTA, NE 68128(402) 614-7022(402) 614-7122 Get Directions Write a Review

NPPES record last updated: May 27, 2010. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Takanari Miyamoto Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TAKANARI MIYAMOTO DDS (NPI 1376730143) is an individual periodontics provider in La Vista, Nebraska, licensed in Nebraska (6823) and active in the NPI registry since September 2007. He has opted out of Medicare through October 28, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1376730143
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameDR. TAKANARI MIYAMOTOCredential: DDS
Location Address12110 PORT GRACE BLVD STE 202La Vista, NE 68128-3190
Mailing Address12110 Port Grace Blvd Ste 202La Vista, NE 68128-3190
Phone(402) 614-7022
Fax(402) 614-7122
Sole ProprietorNo
Enumeration DateSeptember 26, 2007
Last NPPES UpdateMay 27, 2010
✔ NPI 1376730143 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in NE · 6823
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
12110 PORT GRACE BLVD STE 202, La Vista, NE 68128
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Nebraska and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Dr. Takanari Miyamoto Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 28, 2020 through October 28, 2026.

Opt-Out Effective DateOctober 28, 2020
Opt-Out In Effect ThroughOctober 28, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 68128 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.20 typical visit price
range $52.69 – $160.21
Typical copayment $20.30 (range $13.17 – $40.05)
Most-billed visit code 99203
Established Patient
$66.00 typical visit price
range $16.90 – $131.25
Typical copayment $16.50 (range $4.22 – $32.81)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. BRETT JAMES CAWLEY D.D.S.
Dentist (Endodontics)
12110 PORT GRACE BLVD STE 202
LA VISTA, NE 68128
Sarpy County (402) 800-3557

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Takanari Miyamoto's NPI number?

The NPI number for Takanari Miyamoto is 1376730143. It was assigned to this individual provider in the NPPES registry on September 26, 2007.

Where is Takanari Miyamoto located?

Takanari Miyamoto practices at 12110 Port Grace Blvd Ste 202, La Vista, NE 68128. The listed phone number is (402) 614-7022.

What is Takanari Miyamoto's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Takanari Miyamoto enrolled in Medicare?

No. Takanari Miyamoto has opted out of Medicare through October 28, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Takanari Miyamoto accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Nebraska, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Takanari Miyamoto as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Takanari Miyamoto was last updated on May 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.