Active NPI
Earl Barrett Hartzog, D.M.D.
- Dentist
- Denmark, SC
National Provider Identifier
1881820637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4591
- Practice address
- 174 Beech Ave
Denmark, SC 29042 - Phone
- (803) 793-3653
- Fax
- (803) 793-0927
- NPI assigned
- Jun 8, 2009
- Last updated
- Mar 1, 2010
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4591 | SC | Primary |
Addresses
Primary practice location
174 Beech Ave
Denmark, SC 29042
Mailing address
174 Beech Ave
Denmark, SC 29042
Phone (803) 793-3653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- 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 |
|---|---|---|---|---|
| I20140818002352 | SC | Order and Referring Only - Oral Surgery | 7810114634 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Earl B Hartzog DMD PA | Dentist | Past | Accepting new patients |
| Samuel Broughton Baker Jr | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- General Practice Dentistry
- Denmark, SC
- NPI 1487988390
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": "1267401600000",
"number": "1881820637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 BEECH AVE",
"city": "DENMARK",
"state": "SC",
"postal_code": "29042",
"telephone_number": "803-793-3653",
"fax_number": "803-793-0927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 BEECH AVE",
"city": "DENMARK",
"state": "SC",
"postal_code": "29042",
"telephone_number": "803-793-3653",
"fax_number": "803-793-0927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTZOG",
"first_name": "EARL",
"middle_name": "BARRETT",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-08",
"last_updated": "2010-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "4591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denmark, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; 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.