Active NPI
Robert Bruce Drysdale, DDS
- Dentist
- Phila, PA
National Provider Identifier
1992958615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS016146L
- Practice address
- 5501 Woodland Ave
Gpha
Phila, PA 19143 - Phone
- (215) 724-4700
- NPI assigned
- Oct 25, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS016146L | PA | Primary |
Addresses
Primary practice location
5501 Woodland Ave
Gpha
Phila, PA 19143
Mailing address
432 N. 6TH Street
Greater Philadelphia Health Action
Phila, PA 19123
Phone (215) 925-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1022380100001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160210000640 | PA | Order and Referring Only - General Practice | 4385948447 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295395200000",
"number": "1992958615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "432 N. 6TH STREET",
"address_2": "GREATER PHILADELPHIA HEALTH ACTION",
"city": "PHILA",
"state": "PA",
"postal_code": "19123",
"telephone_number": "215-925-2400",
"fax_number": "215-925-9162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 WOODLAND AVE",
"address_2": "GPHA",
"city": "PHILA",
"state": "PA",
"postal_code": "19143",
"telephone_number": "215-724-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRYSDALE",
"first_name": "ROBERT",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-25",
"last_updated": "2011-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS016146L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1022380100001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phila, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.