Active NPI
Michael Joseph Reider, D.D.S.
- General Practice Dentistry
- Elkhart, IN
National Provider Identifier
1780063446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12012309A
- Practice address
- 423 Waterfall Dr
Elkhart, IN 46516-3660 - Phone
- (574) 522-8578
- NPI assigned
- May 27, 2015
- 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 | 12012309A | IN | Primary |
Addresses
Primary practice location
423 Waterfall Dr
Elkhart, IN 46516-3660
Mailing address
51281 Ashley Dr
Granger, IN 46530-8841
Phone (219) 363-9838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20160122002112 | IN | Order and Referring Only - Dentist | 0547563629 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432684800000",
"number": "1780063446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51281 ASHLEY DR",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308841",
"telephone_number": "219-363-9838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "423 WATERFALL DR",
"city": "ELKHART",
"state": "IN",
"postal_code": "465163660",
"telephone_number": "574-522-8578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REIDER",
"first_name": "MICHAEL",
"middle_name": "JOSEPH",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-27",
"last_updated": "2015-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12012309A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; 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.