Active NPI
Tessa Creager
- Dentist
- Fort Wayne, IN
National Provider Identifier
1104138320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011483A
- Practice address
- 1717 S Calhoun St
Fort Wayne, IN 46802-5257 - Phone
- (260) 458-2641
- NPI assigned
- Jul 2, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12011483A | IN | Primary |
Addresses
Primary practice location
1717 S Calhoun St
Fort Wayne, IN 46802-5257
Mailing address
1717 S Calhoun St
Fort Wayne, IN 46802-5257
Phone (260) 458-2641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20150319000900 | IN | Order and Referring Only - Oral Surgery | 1557688165 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011483A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1104138320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 S CALHOUN ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468025257",
"telephone_number": "260-458-2641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 S CALHOUN ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468025257",
"telephone_number": "260-458-2641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CREAGER",
"first_name": "TESSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-02",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011483A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.