Conrad Max Schulte, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11950 Issued in OR

Practice address

16461 William Foss Rd
La Pine, OR 97739-9486

Phone

(541) 907-7020

NPI assigned

Sep 5, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1760964845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20887 GATEWAY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023675",
            "telephone_number": "541-218-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16461 WILLIAM FOSS RD",
            "city": "LA PINE",
            "state": "OR",
            "postal_code": "977399486",
            "telephone_number": "541-907-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTE",
        "first_name": "CONRAD",
        "middle_name": "MAX",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-05",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11950",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103174",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebound Physical Therapy II, LLC
• Alisha Reeves
• Hayley Roark
• Ashley Sandoval, PHARMD
• Briana Schulte, LPC
• Jennifer Ann Slater, LMT
• Martin Lindsey Smart, MD
• Amy Smith Gruebert, LMT
• David Franklin Sonnier
• Sarah Danielle Sperry, PA-C

• General Practice Dentistry in La Pine, OR
• Providers in La Pine, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.

Verify at the official NPI Registry.