Active NPI
Robert E Astleford, D.M.D.
- Dentist
- Nuremberg, PA
National Provider Identifier
1316037708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS021202L
- Practice address
- 75 Pineapple Street
Black Creek Health Center
Nuremberg, PA 18241-0670 - Phone
- (570) 384-3238
- Fax
- (570) 384-3454
- NPI assigned
- Oct 13, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS021202L | PA | Primary |
Addresses
Primary practice location
75 Pineapple Street
Black Creek Health Center
Nuremberg, PA 18241-0670
Mailing address
1084 Route 315
Wilkes-Barre, PA 18702-7012
Phone (570) 825-8741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005392810001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20160317001895 | PA | Order and Referring Only - Oral Surgery | 4183921174 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS021202L | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Health Corporation of Northeastern Pennsylvania | Dentist | 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.
-
- Federally Qualified Health Center (FQHC)
- Wilkes Barre, PA
- NPI 1437351640
Dentist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316037708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1084 ROUTE 315",
"city": "WILKES-BARRE",
"state": "PA",
"postal_code": "187027012",
"telephone_number": "570-825-8741",
"fax_number": "570-825-8990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 PINEAPPLE STREET",
"address_2": "BLACK CREEK HEALTH CENTER",
"city": "NUREMBERG",
"state": "PA",
"postal_code": "182410670",
"telephone_number": "570-384-3238",
"fax_number": "570-384-3454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ASTLEFORD",
"first_name": "ROBERT",
"middle_name": "E",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS021202L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005392810001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nuremberg, PA
Sources for this page
- 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.