Individual provider Active NPI

Meron Negash Andemichael, DDS

  • Dentist
  • Lillington, NC
National Provider Identifier
1821027749
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9628 Issued in NC
Practice address
80 Autumn Fern Trail
East Carolina University School of Dentistry
Lillington, NC 27546
Phone
(252) 737-7350
NPI assigned
Jul 2, 2006
Last updated
Dec 18, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5699 AZ
Dentist 122300000X 9628 NC Primary

Addresses

Primary practice location

80 Autumn Fern Trail
East Carolina University School of Dentistry
Lillington, NC 27546

Mailing address

PO Box 453
Lillington, NC 27546-0453
Phone (910) 984-1556

Other identifiers 1

IdentifierTypeStateIssuer
709644MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160104002216 NC Order and Referring Only - DentistPractitioner - Dentist 5294037529

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9628NCMDPediatric Occupational Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1821027749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 453",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275460453",
            "telephone_number": "910-984-1556",
            "fax_number": "910-984-1557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 AUTUMN FERN TRAIL",
            "address_2": "EAST CAROLINA UNIVERSITY SCHOOL OF DENTISTRY",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "27546",
            "telephone_number": "252-737-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDEMICHAEL",
        "first_name": "MERON",
        "middle_name": "NEGASH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "5699",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "9628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "709644",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lillington, NC

Sources for this page

Verify at the official NPI Registry.