Active NPI
Samuel Alan Passo, D.D.S.
- Periodontics
- Indianapolis, IN
National Provider Identifier
1750355194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12008878
- Practice address
- 7131 Mohawk Lane
Indianapolis, IN 46260 - Phone
- (502) 767-0027
- Fax
- (270) 798-8633
- NPI assigned
- Feb 14, 2006
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2901012290 | MI | |
| Periodontics | 1223P0300X | 040718 | NY | |
| Periodontics | 1223P0300X | DS020240L | PA | |
| Periodontics | 1223P0300X | 5321 | NE | |
| Periodontics | 1223P0300X | 019-020471 | IL | |
| Periodontics | 1223P0300X | 12008878 | IN | Primary |
Addresses
Primary practice location
7131 Mohawk Lane
Indianapolis, IN 46260
Mailing address
7131 Mohawk Lane
Indianapolis, IN 46260
Phone (502) 767-0027
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 |
|---|---|---|---|
| 019-020471 | IL | MD | Periodontist |
| 12008878 | IN | MD | Periodontist |
| 2901012290 | MI | MD | Periodontist |
| 5321 | NE | MD | Periodontist |
| 040718 | NY | MD | Periodontist |
| DS020240L | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373414400000",
"number": "1750355194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7131 MOHAWK LANE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46260",
"telephone_number": "502-767-0027",
"fax_number": "270-798-8633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7131 MOHAWK LANE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46260",
"telephone_number": "502-767-0027",
"fax_number": "270-798-8633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSO",
"first_name": "SAMUEL",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2013-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2901012290",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "040718",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS020240L",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NE",
"license": "5321",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019-020471",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12008878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.