NPIMap

Individual provider Active NPI

Paul Douglas Deitrick Jr., DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Voorhees, NJ
National Provider Identifier
1851527600
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
22DI02798900 Issued in NJ
Practice address
6200 Main St
Voorhees, NJ 08043-4629
Phone
(856) 325-6717
NPI assigned
Jun 8, 2009
Last updated
Mar 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS037281 PA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 22DI02798900 NJ Primary

Addresses

Primary practice location

6200 Main St
Voorhees, NJ 08043-4629

Mailing address

1 Federal St # 200
Camden, NJ 08103-1088
Phone (856) 356-4924

Other practice location 1

2301 E Allegheny Ave Ste 206
Philadelphia, PA 19134-4427
Phone (267) 367-5009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA, NJ3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20151026000111 NY Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 4284943606 Reassigns benefits to 1 organization
I20160707000217 PA Practitioner - Maxillofacial Surgery 4284943606 Reassigns benefits to 1 organization
I20210415001544 NJ Practitioner - Oral SurgeryPractitioner - Dentist 4284943606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Dentist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooper Surgical Associates, PAGroup PAC ID 3274430764, 303 clinicians
Delaware Valley Maxillofacial and Oral Surgery LLCGroup PAC ID 3072567197, 3 clinicians

Practice addresses (Care Compare)

1 Cooper PLZ
Camden, NJ 08103-1461
Phone (856) 342-2000

100 E Lehigh Ave
Southeastern PA Oral Surg
Philadelphia, PA 19125-1012
Phone (215) 707-3613

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.23 of 100Reported as group
Quality
77.64
Promoting interoperability
98
Improvement activities
40
Cost
68.41

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleida Health CurrentSince Aug 1, 2015 Accepting new patients
Cooper Surgical Associates, PA CurrentSince Feb 28, 2021 Accepting new patients
Kaleida Health Current Accepting new patients
Cooper Surgical Associates, PA CurrentSince Feb 28, 2021 Accepting new patients
Kaleida Health CurrentSince Aug 1, 2015 Accepting new patients
Pediatric Dental Associates PLLC Oral and Maxillofacial Surgery Past Accepting new patients

Locations

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

1 Federal St
Ste SW200
Camden, NJ 08103
Phone (856) 356-4920

3 Cooper Plz
Rm 411
Camden, NJ 08103
Phone (856) 342-2270

3 Cooper Plz
Rm 513
Camden, NJ 08103
Phone (856) 963-3518

15 E Euclid Ave
Haddonfield, NJ 08033
Phone (856) 429-1711

1 Plaza Dr
Ste 103
Sewell, NJ 08080
Phone (856) 270-4080

2 Plaza Dr
Ste 203
Sewell, NJ 08080
Phone (856) 270-4100

6200 Main St
Voorhees, NJ 08043
Phone (856) 325-6516

900 Centennial Blvd
Voorhees, NJ 08043
Phone (856) 325-6505

219 Bryant St
Buffalo, NY 14222
Phone (716) 878-7000

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

Interoperability endpoints

  • Direct secure messaging: pdeitrick109655@direct.cooperhealth.edu

Organizations & group practices 7

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1851527600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST # 200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031088",
            "telephone_number": "856-356-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 MAIN ST",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434629",
            "telephone_number": "856-325-6717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 E Allegheny Ave Ste 206",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191344427",
            "country_code": "US",
            "telephone_number": "267-367-5009",
            "fax_number": "267-367-5452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "PAUL",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-08",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS037281",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02798900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

Verify at the official NPI Registry.