Active NPI
Atul Bidarkar
- General Practice Dentistry
- Tyler, TX
National Provider Identifier
1194294926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34662
- Practice address
- 5605 Old Bullard Rd
Tyler, TX 75703-4306 - Phone
- (903) 747-3919
- NPI assigned
- Nov 21, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34662 | TX | Primary |
Addresses
Primary practice location
5605 Old Bullard Rd
Tyler, TX 75703-4306
Mailing address
1499 E Marshall Ave
Longview, TX 75601-6814
Phone (319) 400-8989
Other practice location 1
1499 E Marshall Ave
Longview, TX 75601-6814
Phone (903) 212-4177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- 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 |
|---|---|---|---|---|
| I20190326000329 | TX | Order and Referring Only - Dentist | 4981944139 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34662 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542758400000",
"number": "1194294926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1499 E MARSHALL AVE",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756016814",
"telephone_number": "319-400-8989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5605 OLD BULLARD RD",
"city": "TYLER",
"state": "TX",
"postal_code": "757034306",
"telephone_number": "903-747-3919"
}
],
"practiceLocations": [
{
"address_1": "1499 E Marshall Ave",
"address_purpose": "LOCATION",
"city": "Longview",
"state": "TX",
"postal_code": "756016814",
"country_code": "US",
"telephone_number": "903-212-4177",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BIDARKAR",
"first_name": "ATUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-21",
"last_updated": "2018-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "34662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.