Bradley Packer, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00202833 Issued in CO

Practice address

3506 Lochwood Dr Ste a
Fort Collins, CO 80525-2995

Phone

(970) 377-2557

NPI assigned

Mar 16, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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 Feb 18, 2021 through Feb 18, 2027

Medicare enrollment (NPD)

Not enrolled

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.

• Be-Co-Me LLC

  • Dental Clinic/Center
  • Greeley, CO
  • NPI 1528432473
  NPD (past)
• Collindale Dental General Partnership

  • General Practice Dentistry
  • Fort Collins, CO
  • NPI 1679360481
  NPD (past)
• Timothy M. Owens DDS, PC

  • General Practice Dentistry
  • Fort Collins, CO
  • NPI 1821609983
  NPD (past)

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1679966550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5917 CROSS CREEK DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283152",
            "telephone_number": "507-269-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3506 LOCHWOOD DR STE A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252995",
            "telephone_number": "970-377-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKER",
        "first_name": "BRADLEY",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-16",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00202833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Michael Owens, D.D.S.
• Abigail Oyer
• Oz Psychotherapy LLC
• Anna Marie Pachel, LPTA
• Madison Pachucy, MS CCC-SLP
• Joseph Matthew Paddock, PA-S
• Raymond Padgett, CNIM
• Shawnea Pagat, PA-C
• Charles Lavalle Page, PH.D.
• Ellis Page

• All providers in Fort Collins, CO
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.