Active NPI
Tara Hilleary, DDS
- Dentist
- Blacksville, WV
National Provider Identifier
1437115169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3638
- Practice address
- 5861 Mason-Dixon Highway
Box 72
Blacksville, WV 26521 - Phone
- (304) 432-8211
- Fax
- (304) 432-8213
- NPI assigned
- Apr 21, 2006
- Last updated
- Mar 12, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 3638 | WV | Primary |
Addresses
Primary practice location
5861 Mason-Dixon Highway
Box 72
Blacksville, WV 26521
Mailing address
5861 Mason-Dixon Highway
Box 72
Blacksville, WV 26521
Phone (304) 432-8211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810000893 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180103000226 | WV | Order and Referring Only - Dentist | 8729392519 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3638 | WV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205280000000",
"number": "1437115169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5861 MASON-DIXON HIGHWAY",
"address_2": "BOX 72",
"city": "BLACKSVILLE",
"state": "WV",
"postal_code": "26521",
"telephone_number": "304-432-8211",
"fax_number": "304-432-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5861 MASON-DIXON HIGHWAY",
"address_2": "BOX 72",
"city": "BLACKSVILLE",
"state": "WV",
"postal_code": "26521",
"telephone_number": "304-432-8211",
"fax_number": "304-432-8213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HILLEARY",
"first_name": "TARA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-21",
"last_updated": "2008-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "3638",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810000893",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blacksville, WV
- Clay-Battelle Health Services Association (Clay-Battelle Community Health Center Dental)
- Community Care of West Virginia Inc
- Megan Moore Curry, PA-C
- Seneca Abbie Field, MSW, LGSW
- Wade Vincent Harvey, M.D.
- Andrea Marie Hoekje, PA-C
- Mark A. Hose, MPT
- Jodie Howell, MD
- William Reeves Minor, DO
- Breanna Orrahood
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.