Active NPI
Thomas A. Roed, D.D.S.
- General Practice Dentistry
- Paullina, IA
National Provider Identifier
1841341666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6815
- Practice address
- 119 S. Main St.
Paullina, IA 51046-0179 - Phone
- (712) 949-3614
- Fax
- (712) 949-3614
- NPI assigned
- Jan 16, 2007
- Last updated
- Jul 9, 2007
- 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 | 6815 | IA | Primary |
Addresses
Primary practice location
119 S. Main St.
Paullina, IA 51046-0179
Mailing address
PO Box 179
119 S. Main St.
Paullina, IA 51046-0179
Phone (712) 949-3614
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0196170 | Medicaid | IA |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250701002414 | IA | Order and Referring Only - Other (Non-Physician) | 7113430323 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6815 | IA | MD | General Practice Dentistry |
Interoperability endpoints
- thomas.roed.1@20239.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1841341666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 179",
"address_2": "119 S. MAIN ST.",
"city": "PAULLINA",
"state": "IA",
"postal_code": "510460179",
"telephone_number": "712-949-3614",
"fax_number": "712-949-3614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 S. MAIN ST.",
"city": "PAULLINA",
"state": "IA",
"postal_code": "510460179",
"telephone_number": "712-949-3614",
"fax_number": "712-949-3614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROED",
"first_name": "THOMAS",
"middle_name": "A.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "6815",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0196170",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paullina, IA
- Kelsey Elaine Kruse, MA, LPC, LPCMH, LMHC
- Leah Maier
- Terry B Morris, RPH
- Orange City Municipal Hospital (MillCreek Family Practice)
- Amanda J Rausch, ARNP
- Signature Properties of Paullina LLC (Paullina Care Center)
- South O'Brien Community Schools
- The Current Within Counseling, LLC
- The Current Within Counseling, LLC
- White Drug Enterprises, Inc. (Thrifty White Pharmacy #077)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.