Active NPI
Steven Russell Patty, DDS, PA
- Oral and Maxillofacial Surgery (Dentist)
- Monroe, NC
National Provider Identifier
1922020387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 5322
- Practice address
- 1851 Wellness Blvd
Monroe, NC 28110-7774 - Phone
- (704) 291-7333
- Fax
- (704) 292-1203
- NPI assigned
- Jul 24, 2006
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 5322 | NC | Primary |
Addresses
Primary practice location
1851 Wellness Blvd
Monroe, NC 28110-7774
Mailing address
1851 Wellness Blvd
Monroe, NC 28110-7774
Phone (704) 291-7333
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8996674 | Medicaid | NC | |
| 583212 | Other | PA | UNITED CONCORDIA INS |
| ZN5322 | Medicaid | SC | |
| 96674 | Other | NC | BLUE CROSS BLUE SHIELD NC |
| 328400 | Other | CO | TRIGON BCBS INS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2012 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5322 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331769600000",
"number": "1922020387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1851 WELLNESS BLVD",
"city": "MONROE",
"state": "NC",
"postal_code": "281107774",
"telephone_number": "704-291-7333",
"fax_number": "704-292-1203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1851 WELLNESS BLVD",
"city": "MONROE",
"state": "NC",
"postal_code": "281107774",
"telephone_number": "704-291-7333",
"fax_number": "704-292-1203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTY",
"first_name": "STEVEN",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "DDS, PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2012-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NC",
"license": "5322",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8996674",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS",
"identifier": "583212",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZN5322",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "96674",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIGON BCBS INS",
"identifier": "328400",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.