Active NPI
Jerry Evan Frasure, DMD
- General Practice Dentistry
- Cedarville, OH
National Provider Identifier
1013075282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15428
- Practice address
- 400 N Main St
Cedarville, OH 45314 - Phone
- (937) 766-5207
- Fax
- (937) 766-9303
- NPI assigned
- Dec 4, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15428 | OH | Primary |
Addresses
Primary practice location
400 N Main St
Cedarville, OH 45314
Mailing address
400 N Main St
Cedarville, OH 45314
Phone (937) 766-5207
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 17, 2015 through Jun 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15428 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013075282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 N MAIN ST",
"city": "CEDARVILLE",
"state": "OH",
"postal_code": "45314",
"telephone_number": "937-766-5207",
"fax_number": "937-766-9303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N MAIN ST",
"city": "CEDARVILLE",
"state": "OH",
"postal_code": "45314",
"telephone_number": "937-766-5207",
"fax_number": "937-766-9303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRASURE",
"first_name": "JERRY",
"middle_name": "EVAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "15428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedarville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.