Jerry Bartolome, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DT-1914 Issued in HI

Practice address

302 California Ave
Suite 204
Wahiawa, HI 96786-1841

Phone

(808) 622-2633

Fax

(808) 622-2342

NPI assigned

Feb 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Wahiawa Family Dental Care, LLP

  • General Practice Dentistry
  • Wahiawa, HI
  • NPI 1932288008
  NPD (past)

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225176019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95-1067 HOALIA ST",
            "city": "MILILANI",
            "state": "HI",
            "postal_code": "967896558",
            "telephone_number": "808-384-9273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CALIFORNIA AVE",
            "address_2": "SUITE 204",
            "city": "WAHIAWA",
            "state": "HI",
            "postal_code": "967861841",
            "telephone_number": "808-622-2633",
            "fax_number": "808-622-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTOLOME",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "DT-1914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwinette Baker
• Jean M Balason, PT
• Sabrena H Banford, DPT
• Stephanie Ruiz Barrientos, PA-C
• Joy Armstrong Bartle
• Heribert Balisacan Basilio
• Levie Mae Garo Basilio
• Shantelle Caliboso Bautista
• Allysa Chantel Baxley
• Reinabell Pasco Bayno

• General Practice Dentistry in Wahiawa, HI
• Providers in Wahiawa, HI by specialty
• General Practice Dentistry in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.