Raysham Hayat, DDS
Individual provider Active NPI General Practice Dentistry · Sullivan, MO
NPI 1255907101 · NPPES record last updated Dec 19, 2022
Key facts
- NPI
- 1255907101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2021018765 (MO)
- Practice address
- 101 Progress Pkwy
Sullivan, MO 63080-2359 - Phone
- (844) 853-8937
- NPI assigned
- Jun 1, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221221001716 | MO | Practitioner - Dentist | 3779953401 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021018765 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compass Health, Inc | Current |
Accepting new patients | |
| Compass Health, Inc | Current |
Accepting new patients |
Locations
1800 Community
Clinton, MO 64735
Phone (660) 885-8131
1800 Community
#B
Clinton, MO 64735
3785 New Town Blvd
Saint Charles, MO 63301
Phone (636) 669-2332
101 Progress Pkwy
Sullivan, MO 63080
Phone (573) 468-3555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2021018765 | MO | Yes |
Addresses
Primary practice location
101 Progress Pkwy
Sullivan, MO 63080-2359
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other practice location 1
3785 New Town Blvd
Saint Charles, MO 63301-4358
Phone (844) 853-8937
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 400097855 | Medicaid | MO |
Other providers in Sullivan, MO
- Doris Marie Hallam
- John Hamblin
- Rebecca M Hankins-Farber
- Craig Harris
- Michelle A Hassard
- Brittney Renee Haymer
- Courtney Rae Heine
- Nicole Herbel
- Kirsten Heyer
- Hill Chiropractic P.C.
All providers in Sullivan, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.