Nathan Alexander Phillips, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D1140 Issued in SD

Practice address

301 Oak Tree LN
Dakota Dunes, SD 57049

Phone

(605) 242-0107

Fax

(605) 242-0145

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 7

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 3, 2017 through Apr 3, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Oral Surgery Assocates, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Dakota Dunes, SD
  • NPI 1548304710
  NPD (past)

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1952381899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 OAK TREE LN",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495095",
            "telephone_number": "605-242-0107",
            "fax_number": "605-242-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 OAK TREE LN",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "57049",
            "telephone_number": "605-242-0107",
            "fax_number": "605-242-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "NATHAN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "09366",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SD",
            "license": "D1140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF SD",
            "identifier": "1548304710",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF IA",
            "identifier": "1548304710",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548304710",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF SD",
            "identifier": "1548304710",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548304710",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF IOWA",
            "identifier": "1548304710",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91201365400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Dentistry PC
• Stephanie Marie Peek
• Michael V Persaud, DO
• Jeff Peterson, L.P.C., L.C.P.C.
• Lauren Pfaffle
• Phinit Phisitkul, MD
• Physical Therapy Specialists PC
• Michele Pierce
• Johnalyn Sallise Platt, LPN
• Sarah Plueger, PA-C

• Oral and Maxillofacial Surgery (Dentist) in Dakota Dunes, SD
• Providers in Dakota Dunes, SD by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; 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.

Verify at the official NPI Registry.