Individual provider Active NPI

Benjamin Patrick De Graff, D.M.D.

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1588964282
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9477 Issued in OR
Practice address
7471 SW Barbur Blvd
Portland, OR 97219-2809
Phone
(503) 246-8447
NPI assigned
Oct 27, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9477 OR Primary

Addresses

Primary practice location

7471 SW Barbur Blvd
Portland, OR 97219-2809

Mailing address

7471 SW Barbur Blvd
Portland, OR 97219-2809
Phone (503) 246-8447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160302002696 OR Order and Referring Only - DentistPractitioner - Dentist 4688970528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D9477ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Burlingame Dental Arts General Practice 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": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1588964282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7471 SW BARBUR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972192809",
            "telephone_number": "503-246-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7471 SW BARBUR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972192809",
            "telephone_number": "503-246-8447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GRAFF",
        "first_name": "BENJAMIN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.