Austin Jeffrey Deporter, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

00202761 Issued in CO

Practice address

1600 23Rd Ave
Suite 200
Greeley, CO 80634-6071

Phone

(970) 353-4329

NPI assigned

Oct 1, 2013

Last updated

Sep 2, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

State licenses

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.

• Mountain Ridge Dentistry

  • Dental Clinic/Center
  • Berthoud, CO
  • NPI 1720759228
  NPD Authorized official

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1366879728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "address_2": "SUITE 200",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346071",
            "telephone_number": "970-353-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "address_2": "SUITE 200",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346071",
            "telephone_number": "970-353-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPORTER",
        "first_name": "AUSTIN",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-01",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029653",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00202761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerrica Lynn Dennis
• Dentists of Greeley, LLP (Dentists of Greeley)
• Denver Physical Therapy, P.C.
• Denver Physical Therapy, P.C. (Proactive Greeley)
• Gregory Donald Denzel, DO
• Jane E Derk, PHD
• Sarah Derkum
• Abigail P Derr-Moore, MA
• Cynthia D Derrera, MSW, LCSW
• Derry Counseling Services, LLC

• Dentist in Greeley, CO
• Providers in Greeley, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.