Individual provider Active NPI

Nicholas Barth, D.D.S.

  • Dentist
  • Blountstown, FL
National Provider Identifier
1396090320
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN 19827 Issued in FL
Practice address
19606 Sr 20 W
Blountstown, FL 32424-3916
Phone
(850) 674-5502
Fax
(850) 674-9790
NPI assigned
Jul 16, 2012
Last updated
Jan 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN 19827 FL Primary

Addresses

Primary practice location

19606 Sr 20 W
Blountstown, FL 32424-3916

Mailing address

19606 Sr 20 W
Blountstown, FL 32424-3916
Phone (850) 674-5502

Other identifiers 1

IdentifierTypeStateIssuer
DN 19827OtherFLSTATE OF FLORIDA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20150709002656 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0345552980

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 19827FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Layne & Barth Family Dentistry, PA PastSince Dec 15, 2019 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.

NPI Registry JSON

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1396090320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19606 SR 20 W",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324243916",
            "telephone_number": "850-674-5502",
            "fax_number": "850-674-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19606 SR 20 W",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324243916",
            "telephone_number": "850-674-5502",
            "fax_number": "850-674-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTH",
        "first_name": "NICHOLAS",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 19827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA MEDICAL LICENSE",
            "identifier": "DN 19827",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.