Jason Rea Stetson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS039005 Issued in PA

Practice address

1019 Ghaner Rd
Port Matilda, PA 16870-7235

Phone

(814) 308-0954

Fax

(814) 954-7370

NPI assigned

Apr 5, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1588920318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707235",
            "telephone_number": "814-308-0954",
            "fax_number": "814-954-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707235",
            "telephone_number": "814-308-0954",
            "fax_number": "814-954-7370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STETSON",
        "first_name": "JASON",
        "middle_name": "REA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Sherrick Smith, D.O.
• Samantha Soltis, PA-C
• Anjeli Song, MD
• Barbara Spencer, BCBA
• St. Joseph Institute, LLC
• Stephanie Lynn Stoecklein, CD (DONA)
• Tori Stormer, PA-C
• Colleen Strouse, PHARMD
• William F. Taylor Jr., M.D.
• Bharati Thaker, RPH

• General Practice Dentistry in Port Matilda, PA
• Providers in Port Matilda, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.

Verify at the official NPI Registry.