Active NPI
Michael J Hacken
- Orthodontics and Dentofacial Orthopedics Dentistry
- Granger, IN
National Provider Identifier
1467917278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12012903A
- Practice address
- 51565 Bittersweet Rd
Granger, IN 46530-8859 - Phone
- (574) 277-1211
- Fax
- (574) 277-5812
- NPI assigned
- Feb 6, 2019
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12012903A | IN | Primary |
Addresses
Primary practice location
51565 Bittersweet Rd
Granger, IN 46530-8859
Mailing address
51565 Bittersweet Rd
Granger, IN 46530-8859
Phone (574) 277-1211
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 Mar 1, 2019 through Mar 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012903A | IN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549411200000",
"number": "1467917278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51565 BITTERSWEET RD",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308859",
"telephone_number": "574-277-1211",
"fax_number": "574-277-5812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51565 BITTERSWEET RD",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308859",
"telephone_number": "574-277-1211",
"fax_number": "574-277-5812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKEN",
"first_name": "MICHAEL",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-06",
"last_updated": "2019-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IN",
"license": "12012903A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granger, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.