Individual provider Active NPI

David E Yates, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Evansville, IN
National Provider Identifier
1215084413
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
12010813 Issued in IN
Practice address
550 W Virginia St
Evansville, IN 47710-1614
Phone
(812) 425-5194
Fax
(812) 426-9984
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 12010813A IN
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 12010813 IN Primary

Addresses

Primary practice location

550 W Virginia St
Evansville, IN 47710-1614

Mailing address

550 W Virginia St
Evansville, IN 47710-1614
Phone (812) 425-5194

Other identifiers 1

IdentifierTypeStateIssuer
100246120MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080312000569 IN Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 7315988540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
University of Louisville School of Dentistry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oral Surgery Group of Evansville IncGroup PAC ID 5991880106, 5 clinicians

Practice addresses (Care Compare)

550 W Virginia St
Evansville, IN 47710-1614
Phone (812) 425-5194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12010813INMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
Oral Surgery Group of Evansville, Inc Oral and Maxillofacial Surgery CurrentSince Jan 1, 2007 Accepting new patients

Locations

550 W Virginia St
Evansville, IN 47710
Phone (812) 425-5194

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1215084413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101614",
            "telephone_number": "812-425-5194",
            "fax_number": "812-426-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101614",
            "telephone_number": "812-425-5194",
            "fax_number": "812-426-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YATES",
        "first_name": "DAVID",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010813A",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IN",
            "license": "12010813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100246120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.