Anthony Russell Immediata, DMD, PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5022 Issued in NC

Practice address

7101 Creedmoor Rd
Suite 109
Raleigh, NC 27613-1682

Phone

(919) 846-5500

NPI assigned

Jul 8, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 23, 2017 through Aug 23, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

Practice roles

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.

• K. Kevin Neshat, DDS, MD, PA

  • Oral and Maxillofacial Surgery Clinic/Center
  • Raleigh, NC
  • NPI 1770637779
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609809292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 CREEDMOOR RD",
            "address_2": "SUITE 109",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131682",
            "telephone_number": "919-846-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 CREEDMOOR RD",
            "address_2": "SUITE 109",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131682",
            "telephone_number": "919-846-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMEDIATA",
        "first_name": "ANTHONY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DMD, PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "5022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8994426",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imagination Therapy PLLC
• Matthew Edward Imbrogno, DMD, MSD
• Progress-Jehosheba Ime, MPH
• Erfan Imeni Kashani, D.D.S.
• Lisa Michelle Imhof
• Impact Health Solutions Inc
• Impact Orthopaedics, PA
• In Balance Acupuncture Oriental Medicine LLC
• In Home Health LLC
• In Home Health LLC

• Oral and Maxillofacial Surgery (Dentist) in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.