Specialized Dental Services-jefferson Mall, Pllc - Medicare Dental Clinic in Louisville, KY

Specialized Dental Services-jefferson Mall, Pllc is a medicare enrolled dental clinic (Clinic/center - Dental) in Louisville, Kentucky. The current practice location for Specialized Dental Services-jefferson Mall, Pllc is 5100 Outer Loop, Suite B, Louisville, Kentucky. For appointments, you can reach them via phone at (502) 410-1702. The mailing address for Specialized Dental Services-jefferson Mall, Pllc is Po Box 437169, Louisville, Kentucky and phone number is () -.

Specialized Dental Services-jefferson Mall, Pllc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1033397914. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (502) 410-1702.

Contact Information

Specialized Dental Services-jefferson Mall, Pllc
5100 Outer Loop
Suite B
Louisville
KY 40219-4056
(502) 410-1702
Not Available

Map and Direction


Dental Care Clinic Profile

Full NameSpecialized Dental Services-jefferson Mall, Pllc
SpecialityClinic/Center
Location5100 Outer Loop, Louisville, Kentucky
Authorized Official Name and PositionJeffrey Reibel (CHIEF FINANCIAL OFFICER)
Authorized Official Contact5022548526
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Specialized Dental Services-jefferson Mall, Pllc
Po Box 437169
Louisville
KY 40253-7169

Ph: () -
Specialized Dental Services-jefferson Mall, Pllc
5100 Outer Loop
Suite B
Louisville
KY 40219-4056

Ph: (502) 410-1702

NPI Details:

NPI Number1033397914
Provider Enumeration Date02/04/2008
Last Update Date08/02/2024

Medicare PECOS Information:

Medicare PECOS PAC ID1759531874
Medicare Enrollment IDO20121026000414

Medical Identifiers

Medical identifiers for Specialized Dental Services-jefferson Mall, Pllc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1033397914NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223S0112XDentist - Oral And Maxillofacial Surgery (* (Not Available))Secondary
207L00000XAnesthesiology (* (Not Available))Secondary
261QD0000XClinic/center - Dental (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Specialized Dental Services-jefferson Mall, Pllc acts as a billing entity for following providers:
Provider NameHarold T Daniel
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1831136902
PECOS PAC ID: 4385668037
Enrollment ID: I20060120000235
Provider NameBrent W Mortenson
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1356369169
PECOS PAC ID: 7315954187
Enrollment ID: I20060320000475
Provider NameManeesh Mohan
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1154310985
PECOS PAC ID: 9032354741
Enrollment ID: I20130401000160
Provider NameDavid A Naselsker
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1790944106
PECOS PAC ID: 1557582202
Enrollment ID: I20180911001606
Provider NameAlexander B Musser
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1053756502
PECOS PAC ID: 1052553708
Enrollment ID: I20180918000810
Provider NameStephen H Sutley
Provider TypePractitioner - Oral Surgery
Provider IdentifiersNPI Number: 1124030085
PECOS PAC ID: 5092815944
Enrollment ID: I20190312001836

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.