Individual provider Active NPI

Joseph T Tretta, DO, PA

  • Facial Plastic Surgery Physician
  • Palestine, TX
National Provider Identifier
1508822602
Registry record updated Aug 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
F7643 Issued in TX
Practice address
2900 S Loop 256
Palestine, TX 75801-6958
Phone
(903) 731-2219
Fax
(903) 731-2246
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X F7643 TX Primary

Addresses

Primary practice location

2900 S Loop 256
Palestine, TX 75801-6958

Mailing address

5220 Belfort Rd
Suite 130
Jacksonville, FL 32256-6017

Other identifiers 1

IdentifierTypeStateIssuer
033590303MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Physician Assistant

State licenses

LicenseStateTypeSpecialty
F7643TXMDFacial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deuteronomy Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1508822602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 BELFORT RD",
            "address_2": "SUITE 130",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758016958",
            "telephone_number": "903-731-2219",
            "fax_number": "903-731-2246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRETTA",
        "first_name": "JOSEPH",
        "middle_name": "T",
        "credential": "DO, PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "TX",
            "license": "F7643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033590303",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.