Jessica Sathissarat

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019.028641 Issued in IL

Practice address

88 MDG/SGHJ
4881 Sugar Maple Dr. BLDG 830
Wright-Patterson AFB, OH 45433-5529

Phone

(937) 257-0500

NPI assigned

Mar 23, 2011

Sex

Female

Sole proprietor

Yes

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 OH

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

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

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1427357904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13555 GOLDEN MEADOW DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605449671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 MDG/SGHJ",
            "address_2": "4881 SUGAR MAPLE DR. BLDG 830",
            "city": "WRIGHT-PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SATHISSARAT",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-23",
        "last_updated": "2023-07-06",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019.028641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Ruffe, MD
• David Christopher Rupp, D.D.S.
• Dawn Marie Russell, PA
• Lillian Sai
• Maria Domingo Santos, DDS
• Lori Saturley, RDH
• Paul E Savard, PA-C
• Amy Lynn-Jacobson Schimke, M.D.
• Raymond A Schwab, D.O.
• Matthew Schwartz, MD

• Periodontics in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Periodontics in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.