Active NPI
Charles Fredericks Lydy, D.D.S.
- General Practice Dentistry
- Saginaw, MI
National Provider Identifier
1457329518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12137
- Practice address
- 144 N Frost Dr
Saginaw, MI 48638-7186 - Phone
- (989) 790-0700
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12137 | MI | Primary |
Addresses
Primary practice location
144 N Frost Dr
Saginaw, MI 48638-7186
Mailing address
144 N Frost Dr
Saginaw, MI 48638-7186
Phone (989) 790-0700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4053826 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20150505000154 | MI | Order and Referring Only - Oral Surgery | 3476872912 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12137 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457329518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 N FROST DR",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486387186",
"telephone_number": "989-790-0700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 N FROST DR",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486387186",
"telephone_number": "989-790-0700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYDY",
"first_name": "CHARLES",
"middle_name": "FREDERICKS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "12137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4053826",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.