Individual provider Active NPI

Orest Gregory Bauer, DMD

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1366421000
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
051770 Issued in NY
Practice address
435 E 76TH St
Suite a
New York, NY 10021-2562
Phone
(212) 288-4615
Fax
(866) 709-2669
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 051770 NY Primary
General Practice Dentistry 1223G0001X 59092 CA

Addresses

Primary practice location

435 E 76TH St
Suite a
New York, NY 10021-2562

Mailing address

435 E 76TH St
Suite a
New York, NY 10021-2562
Phone (212) 288-4615

Other identifiers 1

IdentifierTypeStateIssuer
03344869MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20140808000282 NY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4284851692

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
59092CAMDGeneral Practice Dentistry
051770NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327881600000",
    "number": "1366421000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 E 76TH ST",
            "address_2": "SUITE A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212562",
            "telephone_number": "212-288-4615",
            "fax_number": "866-709-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 E 76TH ST",
            "address_2": "SUITE A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212562",
            "telephone_number": "212-288-4615",
            "fax_number": "866-709-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUER",
        "first_name": "OREST",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2012-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051770",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59092",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03344869",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.