Active NPI
Chad Mortensen Thompson, D.D.S.
- General Practice Dentistry
- Portland, TX
National Provider Identifier
1376600155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25211
- Practice address
- 112 Seco Dr
Portland, TX 78374-1458 - Phone
- (361) 563-6213
- Fax
- (361) 853-4084
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D3200 | ID | |
| General Practice Dentistry | 1223G0001X | 25211 | TX | Primary |
Addresses
Primary practice location
112 Seco Dr
Portland, TX 78374-1458
Mailing address
112 Seco Dr
Portland, TX 78374-1458
Phone (361) 563-6213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 16, 2016 through Feb 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3200 | ID | MD | General Practice Dentistry |
| 25211 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cheryl L. Rhoden, DDS, PC | General Practice | Past | Accepting new patients |
| Sabal Dental Airline PLLC | General Practice | 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
- Corpus Christi, TX
- NPI 1336162510
-
- General Practice Dentistry
- Corpus Christi, TX
- NPI 1124549555
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1376600155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 SECO DR",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783741458",
"telephone_number": "361-563-6213",
"fax_number": "361-853-4084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 SECO DR",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783741458",
"telephone_number": "361-563-6213",
"fax_number": "361-853-4084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "CHAD",
"middle_name": "MORTENSEN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D3200",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "25211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.