Individual provider Active NPI

Jason D Sperati, DDS MS

  • Pediatric Dentistry
  • Matthews, NC
National Provider Identifier
1649358078
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7180 Issued in NC
Practice address
1340 Matthews Township Pkwy
Suite 201
Matthews, NC 28105
Phone
(704) 847-4717
Fax
(704) 845-8439
NPI assigned
Nov 2, 2006
Last updated
Dec 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 7180 NC Primary

Addresses

Primary practice location

1340 Matthews Township Pkwy
Suite 201
Matthews, NC 28105

Mailing address

1340 Matthews Township Pkwy
Suite 201
Matthews, NC 28105
Phone (704) 847-4717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20190408001095 NC Practitioner - Dentist 8123369865 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
7180NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Pediatric Dentistry CurrentSince Mar 25, 2019 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 25, 2019 Accepting new patients
Carolinas Medical Center-Northeast Past Accepting new patients
Pediatric Dentistry of Matthews Pediatric Dentistry Past Accepting new patients

Locations

1000 Blythe Blvd
Bldg 2ND
Charlotte, NC 28203
Phone (704) 355-2165

1601 Abbey Pl
Ste 220
Charlotte, NC 28209
Phone (704) 512-2110

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1649358078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 201",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-847-4717",
            "fax_number": "704-845-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 201",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-847-4717",
            "fax_number": "704-845-8439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPERATI",
        "first_name": "JASON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "7180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

Verify at the official NPI Registry.