Active NPI
John Wadas IV
- Dentist
- Munster, IN
National Provider Identifier
1598177644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12012110A
- Practice address
- 417 Ridge Rd
A
Munster, IN 46321-1570 - Phone
- (219) 836-9841
- NPI assigned
- May 23, 2014
- 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 | 12012110A | IN | Primary |
Addresses
Primary practice location
417 Ridge Rd
A
Munster, IN 46321-1570
Mailing address
417 Ridge Rd
A
Munster, IN 46321-1570
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 |
|---|---|---|---|---|
| I20160406001570 | IN | Order and Referring Only - Dentist | 8426356585 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012110A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400803200000",
"number": "1598177644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 RIDGE RD",
"address_2": "A",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463211570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 RIDGE RD",
"address_2": "A",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463211570",
"telephone_number": "219-836-9841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADAS",
"first_name": "JOHN",
"name_suffix": "IV",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-23",
"last_updated": "2014-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12012110A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Munster, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.