Brian Pisarcik

Primary specialty

DentistTaxonomy code 122300000X

License

D14969 Issued in MN

Practice address

1384 109TH Ave NE
Blaine, MN 55434-4542

Phone

(763) 757-6000

NPI assigned

Jul 7, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• White Bear Dentists, PC

  • General Practice Dentistry
  • White Bear Lake, MN
  • NPI 1558725598

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1497433676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 BUERKLE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551101300",
            "telephone_number": "651-337-5695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1384 109TH AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344542",
            "telephone_number": "763-757-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1970 Buerkle Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551101300",
            "country_code": "US",
            "telephone_number": "651-337-5695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PISARCIK",
        "first_name": "BRIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica D Phillips
• Phoenixbird Transportation Inc
• Piic Clinical Services
• Amanda Lucy Pikala, LMFT
• Soaly Pin, PA-C
• Cynthia Marie Polk, REGISTERED NURSE
• Tanager Yvonne Polowchak, MA, LPCC
• Autumn Rose Popowski
• Gregory John Povolny, D.D.S.
• Joseph Francis Prenosil V, MA, LPCC

• Dentist in Blaine, MN
• Providers in Blaine, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.