Active NPI
Diane Hall, DDS
- Dentist
- Cape Girardeau, MO
National Provider Identifier
1639239783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 015479
- Practice address
- 1749 D Independence
Cape Girardeau, MO 63703-5919 - Phone
- (573) 335-6854
- Fax
- (573) 335-9864
- NPI assigned
- Dec 11, 2006
- 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 | 015479 | MO | Primary |
Addresses
Primary practice location
1749 D Independence
Cape Girardeau, MO 63703-5919
Mailing address
1749 D Independence
Cape Girardeau, MO 63703-5919
Phone (573) 335-6854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20170207000572 | MO | Practitioner - Oral Surgery | 3173806734 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Special Care Dental of Missouri LLC | Dentist | Current | Accepting new patients |
Locations
12910 Shelbyville Rd
Louisville, KY 40243
12910 Shelbyville Rd
Ste 300
Louisville, KY 40243
Phone (502) 214-0693
1024 Adams St
Jefferson Cty, MO 65101
Phone (573) 635-1320
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": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639239783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1749 D INDEPENDENCE",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637035919",
"telephone_number": "573-335-6854",
"fax_number": "573-335-9864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1749 D INDEPENDENCE",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637035919",
"telephone_number": "573-335-6854",
"fax_number": "573-335-9864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "DIANE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "015479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.