Active NPI
Elliott T. Deweese, D.M.D., M.S.D.
- Periodontics
- Hermitage, TN
National Provider Identifier
1013304724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 021-002881
- Practice address
- 5651 Frist Blvd Ste 314
Hermitage, TN 37076-2057 - Phone
- (615) 316-9872
- Fax
- (615) 885-9065
- NPI assigned
- Apr 20, 2015
- Last updated
- Dec 12, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Periodontics | 1223P0300X | 021-002881 | IL | Primary |
Addresses
Primary practice location
5651 Frist Blvd Ste 314
Hermitage, TN 37076-2057
Mailing address
5651 Frist Blvd Ste 314
Hermitage, TN 37076-2057
Phone (615) 316-9872
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
- Previously, effective Aug 14, 2018 through Aug 14, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021-002881 | IL | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Russell J. Cecala, D.D.S., M.S., LTD Dba Periocare | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba PerioCare
- Periodontics
- Chicago, IL
- NPI 1841318805
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670803200000",
"number": "1013304724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5651 FRIST BLVD STE 314",
"city": "HERMITAGE",
"state": "TN",
"postal_code": "370762057",
"telephone_number": "615-316-9872",
"fax_number": "615-885-9065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5651 FRIST BLVD STE 314",
"city": "HERMITAGE",
"state": "TN",
"postal_code": "370762057",
"telephone_number": "615-316-9872",
"fax_number": "615-885-9065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWEESE",
"first_name": "ELLIOTT",
"middle_name": "T.",
"name_prefix": "Dr.",
"credential": "D.M.D., M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-20",
"last_updated": "2022-12-12",
"certification_date": "2022-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "021-002881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermitage, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; 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.