Active NPI
Jerry Paul Baethge, DDS
- Dentist
- Sugar Land, TX
National Provider Identifier
1548379118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- TX13239
- Practice address
- 4907 Sandhill Dr
Suite #C
Sugar Land, TX 77479 - Phone
- (281) 565-8822
- Fax
- (281) 565-8901
- NPI assigned
- Aug 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | TX13239 | TX | Primary |
Addresses
Primary practice location
4907 Sandhill Dr
Suite #C
Sugar Land, TX 77479
Mailing address
4907 Sandhill Dr
Suite #C
Sugar Land, TX 77479
Phone (281) 565-8822
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 Jul 23, 2015 through Jul 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13239 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| TX13239 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548379118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4907 SANDHILL DR",
"address_2": "SUITE #C",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "77479",
"telephone_number": "281-565-8822",
"fax_number": "281-565-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4907 SANDHILL DR",
"address_2": "SUITE #C",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "77479",
"telephone_number": "281-565-8822",
"fax_number": "281-565-8901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAETHGE",
"first_name": "JERRY",
"middle_name": "PAUL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "TX13239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sugar Land, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.