Active NPI
Dodi R Woolley
- Dentist
- Demotte, IN
National Provider Identifier
1548526841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12009502
- Practice address
- 534 N Halleck St
Demotte, IN 46310-9553 - Phone
- (219) 987-5733
- NPI assigned
- Apr 11, 2012
- Sex
- Female
- 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 | 12009502 | IN | Primary |
Addresses
Primary practice location
534 N Halleck St
Demotte, IN 46310-9553
Mailing address
534 N Halleck St
PO Box 848
Demotte, IN 46310-9553
Phone (219) 987-5733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160513000552 | IN | Order and Referring Only - Dentist | 3971892035 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009502 | IN | MD | Dentist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1548526841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "534 N HALLECK ST",
"address_2": "PO BOX 848",
"city": "DEMOTTE",
"state": "IN",
"postal_code": "463109553",
"telephone_number": "219-987-5733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "534 N HALLECK ST",
"city": "DEMOTTE",
"state": "IN",
"postal_code": "463109553",
"telephone_number": "219-987-5733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOLLEY",
"first_name": "DODI",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-11",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12009502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Demotte, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; 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.