Prof Takashi Koyama, DMD, PHD FACS is a medicare enrolled "Oral & Maxillofacial Surgery" provider in Fort Pierce, Florida. He went to Perelman School Of Med At The University Of Pennsylvania and graduated in 2000 and has 24 years of diverse experience with area of expertise as Oral Surgery. His current practice location is
2402 Frist Blvd Ste 100, Fort Pierce, Florida. You can reach out to his office (for appointments etc.) via phone at
(772) 461-9700.
Prof Takashi Koyama is licensed to practice in Florida (license number DN16376) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1356459028.
Healthcare Provider's Profile
| Full Name | Prof Takashi Koyama |
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| Gender | Male |
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| Speciality | Oral Surgery |
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| Experience | 24 Years |
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| Location | 2402 Frist Blvd Ste 100, Fort Pierce, Florida |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Prof Takashi Koyama attended and graduated from Perelman School Of Med At The University Of Pennsylvania in 2000
NPI Data:
- NPI Number: 1356459028
- Provider Enumeration Date: 08/25/2006
- Last Update Date: 07/16/2019
Medicare PECOS Information:
- PECOS PAC ID: 4880668417
- Enrollment ID: I20040820000437
Medical Identifiers
Medical identifiers for Prof Takashi Koyama such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1356459028 | NPI | - | NPPES |
| DN 16376 | Other | FL | MEDICAL LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN16376 (Florida) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | DN16376 (Florida) | Primary |
Medical Facilities Affiliation
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Prof Takashi Koyama allows following entities to bill medicare on his behalf.
| Entity Name | Takashi Koyama Dmd Phd Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1558429753
PECOS PAC ID: 1850482092
Enrollment ID: O20070802000321 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Prof Takashi Koyama is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Prof Takashi Koyama, DMD, PHD FACS
2402 Frist Blvd Ste 100,
Fort Pierce, FL 34950-4838
Ph: (772) 461-9700 | Prof Takashi Koyama, DMD, PHD FACS
2402 Frist Blvd Ste 100,
Fort Pierce, FL 34950-4838
Ph: (772) 461-9700 |
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