Individual provider Active NPI

Thomas John Nockerts, D.D.S.

  • Dentist
  • Green Bay, WI
National Provider Identifier
1548384548
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2800 Issued in WI
Practice address
2460 Finger Rd
Green Bay, WI 54302-4210
Phone
(920) 469-8484
Fax
(920) 469-8486
NPI assigned
Mar 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2800 WI Primary

Addresses

Primary practice location

2460 Finger Rd
Green Bay, WI 54302-4210

Mailing address

2460 Finger Rd
Green Bay, WI 54302-4210
Phone (920) 469-8484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20150508001347 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6507185717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2800WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Dental Associates of Green Bay, Inc. 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": "1174089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548384548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-469-8484",
            "fax_number": "920-469-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-469-8484",
            "fax_number": "920-469-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOCKERTS",
        "first_name": "THOMAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "2800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.