Sudheer J Surpure, MD, DDS is a medicare enrolled "Oral & Maxillofacial Surgery" provider in Flagstaff, Arizona. His current practice location is
1600 W University Ave Ste 101, Flagstaff, Arizona. You can reach out to his office (for appointments etc.) via phone at
(928) 247-6200.
Sudheer J Surpure is licensed to practice in California (license number A92044) 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 1235216185.
Healthcare Provider's Profile
| Full Name | Sudheer J Surpure |
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| Gender | Male |
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| Speciality | Oral & Maxillofacial Surgery |
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| Location | 1600 W University Ave Ste 101, Flagstaff, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1235216185
- Provider Enumeration Date: 10/31/2006
- Last Update Date: 10/13/2023
Medicare PECOS Information:
- PECOS PAC ID: 3971538398
- Enrollment ID: I20100210000250
Medical Identifiers
Medical identifiers for Sudheer J Surpure such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1235216185 | NPI | - | NPPES |
| 00A920440 | Medicaid | CA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | OMS 89 (California) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | OMFS SPECIALTY 157 (Oklahoma) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 41157 (Arizona) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | A92044 (California) | 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. Sudheer J Surpure allows following entities to bill medicare on his behalf.
| Entity Name | Sudheer J Surpure Md Dds Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1023609062
PECOS PAC ID: 7810306719
Enrollment ID: O20210505001905 |
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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. Sudheer J Surpure 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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Sudheer J Surpure, MD, DDS
1600 W University Ave Ste 101,
Flagstaff, AZ 86001-3154
Ph: (928) 247-6200 | Sudheer J Surpure, MD, DDS
1600 W University Ave Ste 101,
Flagstaff, AZ 86001-3154
Ph: (928) 247-6200 |
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