Active NPI
John E Definnis, DDS
- General Practice Dentistry
- Berwick, PA
National Provider Identifier
1962582312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS016665L
- Practice address
- 105 W 9TH St
Berwick, PA 18603-3024 - Phone
- (570) 752-4542
- Fax
- (570) 752-6806
- NPI assigned
- Oct 17, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS016665L | PA | Primary |
Addresses
Primary practice location
105 W 9TH St
Berwick, PA 18603-3024
Mailing address
1207 Fowler Ave
Berwick, PA 18603-2307
Phone (570) 759-0122
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005214650001 | Medicaid | PA | |
| 099097 | Other | PA | UNITED CONCORDIA |
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 May 6, 2015 through May 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS016665L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berwick Dental Arts Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Berwick, PA
- NPI 1104906650
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962582312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1207 FOWLER AVE",
"city": "BERWICK",
"state": "PA",
"postal_code": "186032307",
"telephone_number": "570-759-0122",
"fax_number": "570-752-6806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 9TH ST",
"city": "BERWICK",
"state": "PA",
"postal_code": "186033024",
"telephone_number": "570-752-4542",
"fax_number": "570-752-6806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFINNIS",
"first_name": "JOHN",
"middle_name": "E",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS016665L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005214650001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "099097",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwick, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.