Active NPI
Fred G Rew, DDS
- General Practice Dentistry
- Mansfield, LA
National Provider Identifier
1780808287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3194
- Practice address
- 1140 Polk Street
Suite #a
Mansfield, LA 71052 - Phone
- (318) 872-3972
- Fax
- (318) 872-3976
- NPI assigned
- Apr 13, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3194 | LA | Primary |
Addresses
Primary practice location
1140 Polk Street
Suite #a
Mansfield, LA 71052
Mailing address
PO Box 1019
1140 Polk Street Suite #a
Mansfield, LA 71052
Phone (318) 872-3972
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831948 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20151202000159 | LA | Order and Referring Only - Dentist | 2567762214 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3194 | LA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780808287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1019",
"address_2": "1140 POLK STREET SUITE #A",
"city": "MANSFIELD",
"state": "LA",
"postal_code": "71052",
"telephone_number": "318-872-3972",
"fax_number": "318-872-3976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 POLK STREET",
"address_2": "SUITE #A",
"city": "MANSFIELD",
"state": "LA",
"postal_code": "71052",
"telephone_number": "318-872-3972",
"fax_number": "318-872-3976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REW",
"first_name": "FRED",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "3194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831948",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.