Individual provider Active NPI

Alvin J. Kempema, D.D.S.

  • General Practice Dentistry
  • Fort Atkinson, WI
National Provider Identifier
1164415568
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2753-015 Issued in WI
Practice address
1530 Doris Drive
Fort Atkinson, WI 53538-2235
Phone
(920) 563-9373
NPI assigned
Aug 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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 2753-015 WI Primary

Addresses

Primary practice location

1530 Doris Drive
Fort Atkinson, WI 53538-2235

Mailing address

1530 Doris Drive
Fort Atkinson, WI 53538-2235
Phone (920) 563-9373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2753-015WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Garrison HDH LLC General Practice CurrentSince Jun 9, 2024 Accepting new patients

Locations

1530 Doris Dr
Fort Atkinson, WI 53538
Phone (920) 563-9373

Organizations & group practices 1

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": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1164415568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 DORIS DRIVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535382235",
            "telephone_number": "920-563-9373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 DORIS DRIVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535382235",
            "telephone_number": "920-563-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMPEMA",
        "first_name": "ALVIN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2753-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.