Tadele Demisse, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS043969 Issued in PA

Practice address

6120B Woodland Ave
Philadelphia, PA 19142-3224

Phone

(267) 597-3600

NPI assigned

May 13, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NY, PA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Philadelphia Fight

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1760507859
  Medicare reassignment NPD
• Schenectady Family Health Services, Inc.

  dba Hometown Health Centers

  • Family Medicine Physician
  • Schenectady, NY
  • NPI 1396711982
  Medicare reassignment NPD
• Philadelphia Fight

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1487082608
  NPD
• Schenectady Family Health Services, Inc.

  dba Hometown Health Centers Dental at McClellan Street

  • Dental Clinic/Center
  • Schenectady, NY
  • NPI 1457024218
  NPD
• Family Practice & Counseling Services Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1043204811
  NPD (past)
• Family Practice & Counseling Services Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1285628826
  NPD (past)

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1942866280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WISSAHICKON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191444248",
            "telephone_number": "267-597-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120B WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191423224",
            "telephone_number": "267-597-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1044 State St",
            "address_purpose": "LOCATION",
            "city": "Schenectady",
            "state": "NY",
            "postal_code": "123071508",
            "country_code": "US",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4700 Wissahickon Ave Ste 118",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191444248",
            "country_code": "US",
            "telephone_number": "267-597-3600 x5206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "850 N 11th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191231957",
            "country_code": "US",
            "telephone_number": "267-597-3600 x5206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMISSE",
        "first_name": "TADELE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-13",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "061697",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS043969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995513",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIN",
            "identifier": "53099A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSCAR",
            "identifier": "331833",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10000017080506",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah G Demichele, MD
• Lauren Alyssa Demille, LCSW
• Paula Vanessa Demings, DMD
• Sevtap H Demirci, DPM
• Skyler Rohan Demis
• Bisrat Amare Demissie
• Jennifer Demmer
• Olivia Demmers
• Christin Noel Demoss, OD
• Caroline Demosthenes

• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.

Verify at the official NPI Registry.