Individual provider Active NPI

John Reed

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1053469676
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3877 Issued in WI
Practice address
1241 Lombardi Access Rd
Green Bay, WI 54304-4059
Phone
(920) 498-9088
Fax
(920) 498-2146
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3877 WI Primary

Addresses

Primary practice location

1241 Lombardi Access Rd
Green Bay, WI 54304-4059

Mailing address

1241 Lombardi Access Rd
Green Bay, WI 54304-4059
Phone (920) 498-9088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20191219002769 WI Order and Referring Only - DentistPractitioner - Dentist 7315371663

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3877WIMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053469676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 LOMBARDI ACCESS RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044059",
            "telephone_number": "920-498-9088",
            "fax_number": "920-498-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 LOMBARDI ACCESS RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044059",
            "telephone_number": "920-498-9088",
            "fax_number": "920-498-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.