Active NPI
J Alan Hershey, D.D.S
- Dentist
- Lafayette, IN
National Provider Identifier
1679729750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011494A
- Practice address
- 1716 Hartford St
Lafayette, IN 47904-2173 - Phone
- (765) 742-4644
- Fax
- (765) 429-2794
- NPI assigned
- Aug 8, 2008
- Last updated
- Mar 7, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901019835 | MI | |
| Dentist | 122300000X | 12011494A | IN | Primary |
Addresses
Primary practice location
1716 Hartford St
Lafayette, IN 47904-2173
Mailing address
1716 Hartford St
Lafayette, IN 47904-2173
Phone (765) 742-4644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20150622002469 | MI | Order and Referring Only - Dentist | 0648581330 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011494A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1679729750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1716 HARTFORD ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042173",
"telephone_number": "765-742-4644",
"fax_number": "765-429-2794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1716 HARTFORD ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042173",
"telephone_number": "765-742-4644",
"fax_number": "765-429-2794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERSHEY",
"first_name": "J",
"middle_name": "ALAN",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-08",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901019835",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011494A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.