Jason Bodnar, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7956 Issued in NC

Practice address

103 Haywood Park Dr
Clyde, NC 28721-4405

Phone

(828) 627-1050

Fax

(828) 627-1056

NPI assigned

Jul 24, 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2022 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380672000000",
    "number": "1538181706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SAWYERS PHEASANT LANE",
            "city": "CANDLER",
            "state": "NC",
            "postal_code": "287155108",
            "telephone_number": "828-230-4685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 HAYWOOD PARK DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287214405",
            "telephone_number": "828-627-1050",
            "fax_number": "828-627-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODNAR",
        "first_name": "JASON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2013-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9025V",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1702701",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901866",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blue Ridge Community Health Services, Inc
• Blue Ridge Dermatology PA
• Blue Ridge Family Practice Assoc
• Blue Ridge Ultrasound, Inc.
• Bodnar & Wyatt, PLLC
• Harold Breakey
• Colin James Bridger, MPT
• Cacye Burbach
• Daryn Burgdorf, PT
• Russell Edward Buss, M.D.

• General Practice Dentistry in Clyde, NC
• Providers in Clyde, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.