Individual provider Active NPI

Mark Gary Fohey, DDS

  • General Practice Dentistry
  • Monona, IA
National Provider Identifier
1780787374
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7066 Issued in IA
Practice address
101 Franklin
Monona, IA 52159
Phone
(563) 539-4651
Fax
(563) 539-4653
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7066 IA Primary

Addresses

Primary practice location

101 Franklin
Monona, IA 52159

Mailing address

PO Box 965
Monona, IA 52159
Phone (563) 539-4651

Other identifiers 2

IdentifierTypeStateIssuer
0031633MedicaidIA
1031633OtherIAMEDICAID FOR WAUKON

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20180529000808 IA Order and Referring Only - DentistPractitioner - Dentist 6406816180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4475WIMDChiropractor
7066IAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Iowa Dental Professional Corporation General Practice Past Accepting new patients
Dental Associates of Prairie Du Chien PC General Practice Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1780787374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 965",
            "city": "MONONA",
            "state": "IA",
            "postal_code": "52159",
            "telephone_number": "563-539-4651",
            "fax_number": "563-539-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FRANKLIN",
            "city": "MONONA",
            "state": "IA",
            "postal_code": "52159",
            "telephone_number": "563-539-4651",
            "fax_number": "563-539-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOHEY",
        "first_name": "MARK",
        "middle_name": "GARY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "7066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031633",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FOR WAUKON",
            "identifier": "1031633",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monona, IA

Sources for this page

Verify at the official NPI Registry.