Individual provider Active NPI

Michael Avery Pitt, DDS

  • General Practice Dentistry
  • Evansville, IN
National Provider Identifier
1396817151
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8019 Issued in IN
Practice address
801 N Weinbach Ave
Evansville, IN 47711-5321
Phone
(812) 476-6176
Fax
(812) 476-3602
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8019 IN Primary

Addresses

Primary practice location

801 N Weinbach Ave
Evansville, IN 47711-5321

Mailing address

801 N Weinbach Ave
Evansville, IN 47711-5321
Phone (812) 476-6176

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20150608002257 IN Order and Referring Only - DentistPractitioner - Dentist 6406177088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8019INMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396817151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N WEINBACH AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477115321",
            "telephone_number": "812-476-6176",
            "fax_number": "812-476-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N WEINBACH AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477115321",
            "telephone_number": "812-476-6176",
            "fax_number": "812-476-3602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITT",
        "first_name": "MICHAEL",
        "middle_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "8019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.