Individual provider Active NPI

Ted Marek Poczatek, D.M.D.

  • General Practice Dentistry
  • Bessemer, AL
National Provider Identifier
1154423705
Registry record updated Dec 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5257 Issued in AL
Practice address
5751 Pocahontas Rd
Suite a
Bessemer, AL 35022-5478
Phone
(205) 477-4242
Fax
(205) 477-4243
NPI assigned
Sep 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2012

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 5257 AL Primary

Addresses

Primary practice location

5751 Pocahontas Rd
Suite a
Bessemer, AL 35022-5478

Mailing address

5751 Pocahontas Rd
Suite a
Bessemer, AL 35022-5476
Phone (205) 477-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20180219002095 AL Practitioner - Dentist 7416195243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5257ALMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354838400000",
    "number": "1154423705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5751 POCAHONTAS RD",
            "address_2": "SUITE A",
            "city": "BESSEMER",
            "state": "AL",
            "postal_code": "350225476",
            "telephone_number": "205-477-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5751 POCAHONTAS RD",
            "address_2": "SUITE A",
            "city": "BESSEMER",
            "state": "AL",
            "postal_code": "350225478",
            "telephone_number": "205-477-4242",
            "fax_number": "205-477-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POCZATEK",
        "first_name": "TED",
        "middle_name": "MAREK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-03",
        "last_updated": "2012-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bessemer, AL

Sources for this page

Verify at the official NPI Registry.