Active NPI
Bradley Scott Burtwistle, D.D.S.
- General Practice Dentistry
- Monument, CO
National Provider Identifier
1013359876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 00202045
- Practice address
- 325 2ND St Ste a
Monument, CO 80132-7935 - Phone
- (719) 481-4949
- Fax
- (719) 481-4989
- NPI assigned
- Jul 22, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 00202045 | CO | Primary |
Addresses
Primary practice location
325 2ND St Ste a
Monument, CO 80132-7935
Mailing address
325 2ND St Ste a
PO Box 492
Monument, CO 80132-7935
Phone (719) 481-4949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- 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 |
|---|---|---|---|---|
| I20160801001908 | CO | Order and Referring Only - Dentist | 2365735115 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00202045 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brad Burtwistle DDS, PC | General Practice | Past | Accepting new patients |
| A J Gerathy Jr DMD LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402012800000",
"number": "1013359876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 2ND ST STE A",
"address_2": "PO BOX 492",
"city": "MONUMENT",
"state": "CO",
"postal_code": "801327935",
"telephone_number": "719-481-4949",
"fax_number": "719-481-4989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 2ND ST STE A",
"city": "MONUMENT",
"state": "CO",
"postal_code": "801327935",
"telephone_number": "719-481-4949",
"fax_number": "719-481-4989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURTWISTLE",
"first_name": "BRADLEY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-22",
"last_updated": "2014-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "00202045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monument, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; 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.