Fred Rodems, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

36553 Issued in NY

Practice address

1947 Ridge Rd
West Seneca, NY 14224-3339

Phone

(716) 675-9777

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

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

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.

• Professional Oral Surgery Alliance of Upstate New York, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Depew, NY
  • NPI 1740088608
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421884800000",
    "number": "1497799647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S BUFFALO ST",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411239",
            "telephone_number": "716-592-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 RIDGE RD",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243339",
            "telephone_number": "716-675-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODEMS",
        "first_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2015-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "36553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00832155",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA HEALTHCARE",
            "identifier": "00020919401",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mallory Noelle Robel, PA-C
• Deborah J Robida, PT
• Emily Robson
• Hannah Rae Roche, M.A. TSSLD CF-SLP
• Robert R Roche, D.O.
• Gissela Rodriguez
• Jordan Elizabeth Rogers
• Rolando Rojas, RN
• Jennifer Lynn Rojek, M.D.
• Kristina Roksvold

• Oral and Maxillofacial Surgery (Dentist) in West Seneca, NY
• Providers in West Seneca, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.