Active NPI
Jon Eugene Piche, DDS, MS
- Periodontics
- Yorktown, VA
National Provider Identifier
1417002031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401006503
- Practice address
- 4310 George Washington Memorial Hwy
Yorktown, VA 23692-2880 - Phone
- (757) 874-1777
- Fax
- (757) 874-3236
- NPI assigned
- Jan 24, 2007
- Last updated
- Jul 17, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401006503 | VA | Primary |
Addresses
Primary practice location
4310 George Washington Memorial Hwy
Yorktown, VA 23692-2880
Mailing address
4310 George Washington Memorial Hwy
Yorktown, VA 23692-2880
Phone (757) 874-1777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000880911 | Other | VA | UNITED CONCORDIA ID NUM |
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 Jan 31, 2014 through Jan 31, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401006503 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342483200000",
"number": "1417002031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4310 GEORGE WASHINGTON MEMORIAL HWY",
"city": "YORKTOWN",
"state": "VA",
"postal_code": "236922880",
"telephone_number": "757-874-1777",
"fax_number": "757-874-3236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4310 GEORGE WASHINGTON MEMORIAL HWY",
"city": "YORKTOWN",
"state": "VA",
"postal_code": "236922880",
"telephone_number": "757-874-1777",
"fax_number": "757-874-3236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICHE",
"first_name": "JON",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2012-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401006503",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID NUM",
"identifier": "000880911",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yorktown, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.