Individual provider Active NPI

Peter A Sudack, DDS

  • General Practice Dentistry
  • North Miami, FL
National Provider Identifier
1659691764
Registry record updated Mar 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN19564 Issued in FL
Practice address
11645 Biscayne Blvd
Suite 403
North Miami, FL 33181-3155
Phone
(305) 538-8835
Fax
(305) 938-4044
NPI assigned
Jun 11, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 055663 NY
General Practice Dentistry 1223G0001X DN19564 FL Primary

Addresses

Primary practice location

11645 Biscayne Blvd
Suite 403
North Miami, FL 33181-3155

Mailing address

11645 Biscayne Blvd
Suite 403
North Miami, FL 33181-3155
Phone (305) 538-8835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20160413002258 FL Order and Referring Only - DentistPractitioner - Dentist 7517265242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
055663NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Miami Beach Community Health Center Inc 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": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459123200000",
    "number": "1659691764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 BISCAYNE BLVD",
            "address_2": "SUITE 403",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331813155",
            "telephone_number": "305-538-8835",
            "fax_number": "305-938-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 BISCAYNE BLVD",
            "address_2": "SUITE 403",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331813155",
            "telephone_number": "305-538-8835",
            "fax_number": "305-938-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDACK",
        "first_name": "PETER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-11",
        "last_updated": "2016-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "055663",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Miami, FL

Sources for this page

Verify at the official NPI Registry.