Active NPI
Todd L Pedersen, DDS
- General Practice Dentistry
- Schuyler, NE
National Provider Identifier
1740583640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5633
- Practice address
- 1005 A St
Schuyler, NE 68661-1927 - Phone
- (402) 352-5566
- Fax
- (402) 352-5566
- NPI assigned
- Dec 15, 2010
- Last updated
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5633 | NE | Primary |
Addresses
Primary practice location
1005 A St
Schuyler, NE 68661-1927
Mailing address
P O Box 228
Schuyler, NE 68661-1927
Phone (402) 352-5566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025193700 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5633 | NE | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pedersen Dental | General Practice | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Schuyler, NE
- NPI 1750456950
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1740583640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 228",
"city": "SCHUYLER",
"state": "NE",
"postal_code": "686611927",
"telephone_number": "402-352-5566",
"fax_number": "402-352-5316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 A ST",
"city": "SCHUYLER",
"state": "NE",
"postal_code": "686611927",
"telephone_number": "402-352-5566",
"fax_number": "402-352-5566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "TODD",
"middle_name": "L",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-15",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "5633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025193700",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Schuyler, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.