Serge A Prescott, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN19399 Issued in FL

Practice address

4161 Tamiami TRL
Suite 3171
Port Charlotte, FL 33952-9204

Phone

(941) 255-8500

Fax

(941) 255-8503

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network
• FL HMO C-SNP

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20881/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309910400000",
    "number": "1013053487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4161 TAMIAMI TRL",
            "address_2": "SUITE 3171",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529204",
            "telephone_number": "941-255-8500",
            "fax_number": "941-255-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 TAMIAMI TRL",
            "address_2": "SUITE 3171",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529204",
            "telephone_number": "941-255-8500",
            "fax_number": "941-255-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESCOTT",
        "first_name": "SERGE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35537",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neil Garrett Powell Jr., MD
• Mark Prebonich, M.D.
• Precision Medical Imaging
• Premier Dental and Orthodontics of Port Charlotte
• Premier Health Services PA
• Kimberly Presnell, APRN
• Amelia Adair Priede
• Primary Care 2 You LLC
• Primehealth Urgent Care LLC
• Ana Carolina Proano, MD

• General Practice Dentistry in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.

Verify at the official NPI Registry.