Randy Demetter, DDS in Boise, ID - Medicare Dentist Provider

Randy Demetter, DDS is a medicare enrolled "Dentist - Periodontics" provider in Boise, Idaho. His current practice location is 140 E Boise Ave, Boise, Idaho. You can reach out to his office (for appointments etc.) via phone at (208) 385-9228.

Randy Demetter is licensed to practice in Idaho (license number D-4831-PE) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1275941288.

Contact Information

	Randy Demetter, DDS
	140 E Boise Ave, Boise, ID 83706-4302
	(208) 385-9228
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Randy Demetter
Gender	Male
Speciality	Dentist - Periodontics
Location	140 E Boise Ave, Boise, Idaho
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1275941288
Provider Enumeration Date: 07/23/2014
Last Update Date: 04/05/2023

Medicare PECOS Information:

PECOS PAC ID: 4183010259
Enrollment ID: I20240510002925

Medical Identifiers

Medical identifiers for Randy Demetter such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1275941288	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223P0300X	Dentist - Periodontics	ETN283 (Texas)	Secondary
1223P0300X	Dentist - Periodontics	D-4831-PE (Idaho)	Primary

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. Randy Demetter allows following entities to bill medicare on his behalf.

Entity Name	Periodontal Health Specialists Of Idaho
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1689077026 PECOS PAC ID: 5799142659 Enrollment ID: O20230607003586

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. Randy Demetter 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
Randy Demetter, DDS 140 E Boise Ave, Boise, ID 83706-4302 Ph: (208) 385-9228	Randy Demetter, DDS 140 E Boise Ave, Boise, ID 83706-4302 Ph: (208) 385-9228

Reviews and Comments

Dentist in Boise, ID

Dr. Jace C. Hansen, DMD, MS Dentist Medicare: Not Enrolled in Medicare Practice Location: 6019 N. Eagle Rd., Boise, ID 83713 Phone: 208-377-2777 Fax: 208-377-3075
Dr. Helen Thu Smith, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 8321 W Overland Rd, Boise, ID 83709 Phone: 208-605-3638
Benjamin A Hulbert, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 9733 W Ustick Rd, Boise, ID 83704 Phone: 208-375-8720
Hanna Castleberry, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 1175 E Parkcenter Blvd, Boise, ID 83706 Phone: 208-888-5544
Dr. Errol Chandler Fife, DDS Dentist Medicare: Medicare Enrolled Practice Location: 1675 Hill Rd, Boise, ID 83702 Phone: 208-342-3695 Fax: 208-342-4065
Dr. Robert T Peck, DMD Dentist Medicare: Medicare Enrolled Practice Location: 7480 Northview St, Boise, ID 83704 Phone: 208-322-2727 Fax: 208-375-0225
Mr. John Stanley Kriz, DDS Dentist Medicare: Medicare Enrolled Practice Location: 7235 Emerald St, Suite B, Boise, ID 83704 Phone: 208-376-7740 Fax: 208-376-0468

Randy Demetter, DDS - Medicare Dentist in Boise, ID