Individual provider Active NPI

Gregory Norman Bemis, D.M.D.

  • General Practice Dentistry
  • Cheshire, CT
National Provider Identifier
1215079363
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10632 Issued in CT
Practice address
314 W Main St
Cheshire, CT 06410-2415
Phone
(203) 250-3446
Fax
(203) 250-3446
NPI assigned
Feb 13, 2007
Last updated
Dec 28, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 052587 NY
General Practice Dentistry 1223G0001X 10632 CT Primary

Addresses

Primary practice location

314 W Main St
Cheshire, CT 06410-2415

Mailing address

314 W Main St
Cheshire, CT 06410-2415
Phone (203) 250-3446

Other identifiers 1

IdentifierTypeStateIssuer
02801825MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20150330000192 CT Order and Referring Only - DentistPractitioner - Dentist 5597082636

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
052587NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
New Leaf Family Dental PC General Practice 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514419200000",
    "number": "1215079363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W MAIN ST",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064102415",
            "telephone_number": "203-250-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 W MAIN ST",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064102415",
            "telephone_number": "203-250-3446",
            "fax_number": "203-250-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEMIS",
        "first_name": "GREGORY",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2017-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052587",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "10632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02801825",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheshire, CT

Sources for this page

Verify at the official NPI Registry.