Active NPI
Andrew Thomas Chadbourn, DMD
- Dentist
- Blaine, MN
National Provider Identifier
1184030686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D13439
- Practice address
- 9120 Baltimore St NE
Blaine, MN 55449-4337 - Phone
- (763) 786-1560
- Fax
- (763) 786-4390
- NPI assigned
- Jul 3, 2014
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D13439 | MN | Primary |
Addresses
Primary practice location
9120 Baltimore St NE
Blaine, MN 55449-4337
Mailing address
9120 Baltimore St NE
Blaine, MN 55449-4337
Phone (763) 786-1560
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 16, 2019 through Oct 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13439 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northpark Dental | Dentist | Past | Accepting new patients |
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.
-
- Dentist
- Blaine, MN
- NPI 1710161500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404345600000",
"number": "1184030686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9120 BALTIMORE ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494337",
"telephone_number": "763-786-1560",
"fax_number": "763-786-4390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9120 BALTIMORE ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494337",
"telephone_number": "763-786-1560",
"fax_number": "763-786-4390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHADBOURN",
"first_name": "ANDREW",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-03",
"last_updated": "2014-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D13439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.