Individual provider Active NPI

John Robert Pasqual, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Delray Beach, FL
National Provider Identifier
1124000575
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN17270 Issued in FL
Practice address
4600 Linton Blvd
Ste 220
Delray Beach, FL 33445-6600
Phone
(561) 900-9080
Fax
(561) 900-9084
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X DS030473L PA
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X DN17270 FL
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN17270 FL Primary

Addresses

Primary practice location

4600 Linton Blvd
Ste 220
Delray Beach, FL 33445-6600

Mailing address

4600 Linton Blvd
Ste 220
Delray Beach, FL 33445-6600
Phone (561) 900-9080

Other identifiers 1

IdentifierTypeStateIssuer
1011842730001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20120813000356 FL Practitioner - Oral Surgery 5597773077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 2003
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4600 Linton Blvd
Suite 220
Delray Beach, FL 33445-6600
Phone (561) 900-9080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS030473LPAMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
John R. Pasqual DMD PA Oral & Maxillofacial Surgery CurrentSince May 23, 2012 Accepting new patients
Pasqual Associates Oral & Maxillofacial Surgery PastSince May 7, 2012 Accepting new patients
Dr. John R. Pasqual D.M.D., P.a. Oral and Maxillofacial Surgery PastSince May 23, 2012 Accepting new patients

Locations

4600 Linton Blvd
Ste 220
Delray Beach, FL 33445
Phone (561) 900-9080

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cornell Institute for Rehabilitation MedicineBoynton Beach, FL, CCN 10T002 Hospital Corporate Director Oct 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492387200000",
    "number": "1124000575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 LINTON BLVD",
            "address_2": "STE 220",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334456600",
            "telephone_number": "561-900-9080",
            "fax_number": "561-900-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 LINTON BLVD",
            "address_2": "STE 220",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334456600",
            "telephone_number": "561-900-9080",
            "fax_number": "561-900-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASQUAL",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2017-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS030473L",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "DN17270",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN17270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011842730001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delray Beach, FL

Sources for this page

Verify at the official NPI Registry.