Active NPI
Thomas Michael Hickey, D.M.D.
- Dentist
- Port St Lucie, FL
National Provider Identifier
1346528692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN11997
- Practice address
- 1202 S.E. Port Saint Lucie Boulevard Suite B
Family Dentistry
Port St Lucie, FL 34952 - Phone
- (772) 335-3088
- Fax
- (772) 398-0041
- NPI assigned
- Aug 3, 2011
- 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 | DN11997 | FL | Primary |
Addresses
Primary practice location
1202 S.E. Port Saint Lucie Boulevard Suite B
Family Dentistry
Port St Lucie, FL 34952
Mailing address
1202 S.E. Port Saint Lucie Boulevard
Family Dentistry
Port St Lucie, FL 34952
Phone (772) 335-3088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN11997 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Dental Alliance of Florida, PLLC | Past | Accepting new patients | |
| Itd Associates, P.a. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Fort Pierce, FL
- NPI 1073832176
-
- General Practice Dentistry
- Port St Lucie, FL
- NPI 1750938072
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312329600000",
"number": "1346528692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 S.E. PORT SAINT LUCIE BOULEVARD",
"address_2": "FAMILY DENTISTRY",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "34952",
"telephone_number": "772-335-3088",
"fax_number": "772-398-0041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 S.E. PORT SAINT LUCIE BOULEVARD SUITE B",
"address_2": "FAMILY DENTISTRY",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "34952",
"telephone_number": "772-335-3088",
"fax_number": "772-398-0041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKEY",
"first_name": "THOMAS",
"middle_name": "MICHAEL",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-03",
"last_updated": "2011-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN11997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.