Active NPI
William Leonard Padner III, D.M.D.
- General Practice Dentistry
- Berwick, PA
National Provider Identifier
1083711295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS028567L
- Practice address
- 205 Chestnut Street
Berwick, PA 18603 - Phone
- (570) 752-2071
- Fax
- (570) 752-4692
- NPI assigned
- Sep 20, 2006
- 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 | DS028567L | PA | Primary |
Addresses
Primary practice location
205 Chestnut Street
Berwick, PA 18603
Mailing address
205 Chestnut Street
Berwick, PA 18603
Phone (570) 752-2071
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0014331240001 | Other | PA | DEPARTMENT OF PUBLIC WELF |
| 0014331240001 | Medicaid | PA | |
| 196470 | Other | UNITED CONCORDIA | |
| 196470 | Other | BLUE SHIELD OF PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20151015001403 | PA | Order and Referring Only - Dentist | 0941519847 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS028567L | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234224000000",
"number": "1083711295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 CHESTNUT STREET",
"city": "BERWICK",
"state": "PA",
"postal_code": "18603",
"telephone_number": "570-752-2071",
"fax_number": "570-752-4692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 CHESTNUT STREET",
"city": "BERWICK",
"state": "PA",
"postal_code": "18603",
"telephone_number": "570-752-2071",
"fax_number": "570-752-4692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PADNER",
"first_name": "WILLIAM",
"middle_name": "LEONARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2009-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS028567L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF PUBLIC WELF",
"identifier": "0014331240001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0014331240001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "196470",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF PA",
"identifier": "196470",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwick, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2009; 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.